This report is based on a case study that sought to understand the use of central venous devices by medical personnel and the infections that arises from the use of the devices. Central venous devices are devices that are used in the extraction of blood samples used for diagnosis purposes(James et al. 2008). They are also used in the provision of intravenous treatments such as chemotherapy. Since these devices are always inserted in body parts, then, high degree of hygiene should be observed. Failure to observe hygiene standards often leads other infections (O’grady et al. 2011). The purpose of this report is to discuss the strategies that can be used to prevent occurrence of catheter related infections in the future. In this report, a brief background of the use of the central venous devices will be discussed (Mermel et al. 2009). The report will further give the infections and the risks associated with the use of these methods, Strategies to prevent the infection related to the use of central venous devices and the outcome of implementation.
The use of catheters in hospitals is inevitable. This is due to the fact that they aid in the extraction and introduction of fluids into the body of the patient. They provide easy access to the blood vessels(Timsit et al 2009). Despite this use, application of such devices to patients is often accompanied with several infections and complications. Central venous catheters mostly lead to many infections as opposed to the use of peripheral catheter
A lot of funds is spend by hospitals in the care of patients who often suffers as a result of using these devices. This in turn leads to increased hospital spending (Zingg et al. 2009). To ensure that the cost associated with the care and treatment of patient is controlled, appropriate strategies need to be put in place and implemented (Tong, Davis, Eichenberger, Holland & Fowler, 2015). A report by Center for Disease Control notes that implementation of prevention strategies is a not a one man or one department responsibility. It is a responsibility that involves several parties including; the patients, management in the health sector, medical practitioner who have direct contact with the patients among others. The strategies highlighted by this report will be discussed in subsequent sections (Francolini, & Donelli, 2010).
1.Education
The skills possessed by the medical practitioner who inserts catheters into patients have an effect in the number of infections recorded either positively or negatively. The higher the skills of the professional the lower the rate of infections. Continuous training of the staff is critical in equipping heath care providers with necessary skills. This will help to reduce the number of infections recorded and reduce maintenance cost of sick patients (Lok & Mokrzycki, 2011).
The place where a catheter is placed in the body should be keenly chosen. This is because some parts of the body are at a higher risk of developing catheter related infections and thrombophlebitis (Umscheid et al. 2011). Adults who have catheters inserted in their lower extremities are more likely to suffer from catheter related infection as opposed to those who have them inserted in upper extremity parts. It has been proved that hand veins are less prone to phlebitis when compared to veins on the upper part of the arm (Marschall et al. 2008). Healthcare workers are advised to place insertions in subclavian part rather than in femoral part. This is because femoral parts are associated with high risk. In locating the right site to insert the catheter, health care workers are advised to use ultra sound.
Catheter made of Teflon or polyurethane has been confirmed to be safer to use when compared to those made of polyvinyl chloride or polyethylene. Health practitioners are therefore advised to use those that are less risky.
Maintenance of good hygiene condition before, during and after insertion is very critical in preventing infections (Pronovost et al. 2010). Proper hand hygiene can be achieved through use of alcohol based product or antibacterial soap. Disposable gloves are also recommended for use.
Studies conducted have proved that the use of 2% aqueous chlorhexidinegluconate is more effective in cleaning catheter insertion sites when compared to the use of povidone iodine (Allegranzi & Pittet, 2009).
Both semipermeable polyurethane and gauze dressing are recommended to be used in dressing catheter sites. They have been found to provide adequate protection to the catheter insertion area (Labeau et al 2009).
Catheter-relation bloodstream infections (CRBSI) are better controlled by use of protection devices that lack sutures as compared to those protection devices that have sutures (Oliveira, Nasr, Brindle & Wales, 2012).
In-line filters play a significant role in mitigating infusions-related phlebitis. Several benefits can be accrued from the use of in-line filters. In-line filters reduce the risk of infection arising from proximal contamination, and aid in the elimination of particulate matter that may lead to contamination of IV fluids (Meddings et al. 2013).
Use of a mask, a cap, a sterile gown, sterile gloves and a large sterile drape when inserting a catheter helps in the mitigation of catheter-related infections. This precaution measure helps in ensuring that the condition that may promote thriving of micro organizing is destroyed.
1.Systems based intervention
As seen from the discussion above, there are several strategies that can be used in prevention of catheter related infections. These strategies can be effectively implemented through application of system- based interventions. There should be a universal catheter checklist which can be followed by all practitioners. This will ensure that there is uniformity and standardized to be procedure followed (Chen, Yu & Sun, 2013).
Surveillance is one of the methods used in the prevention of health care associated infections. Surveillance process entails collecting information related to health related occurrence, analyses it and give out its relevance in prevention of infections. Surveillance facilitates observation of the rate of catheter related blood stream infections and how they can be controlled. The use of surveillance systems in hospitals leads to significant reduction in the rate of infection.
There are many risk factors which puts patients at a risk of contracting catheter related infections. They include; the time taken by the patient in the hospital, the time in which a catheter remains in the body among others. Management of these risk factors contribute to a significant reduction in catheter related infections. With proper implementation of the strategies discussed above, then the risk factors can be reduced.
Service provision should be organized in such a way that each step in the process is monitored, and evaluated to ensure that it meets the set standards. Meeting standards ensures that quality is assured. There should be regular checks in at different steps of the process.
Proper implementation of the above strategies will lead to the following results;
The main aim of these strategies is to ensure that catheter related infections are prevented or reduced. Implementation of these strategies will lead to significant reduction of catheter related infections.
Conclusion
Infections brought by use of catheters are a great concern for many. However, with proper implementation of the prevention strategies, significant reduction can be achieved. Several measures need to be taken into consideration when dealing with these infections. Prevention should begin by providing necessary training to the health care workers who perform catheter insertion. All the steps involved in the process should be monitored to ensure that quality standards are maintained. Hand hygiene is crucial to all the staff who participates in the process. They can achieve this through use of alcohol based product in cleaning. Maximal sterile barrier precaution should be used at the point of catheter insertion. Sterile gloves, masks, cap and a large sterile drop should be used as protective gears. Catheter insertion site should be keenly chosen. Some sites bear higher risk of infections when compared to others. Chlorhexidine should be used as an antisepsis for the skin. In the absence of chlorhexidine, a tinchure of iodine can be used. The skin should be thoroughly disinfected to kill all the microorganisms that may cause infections. Finally, a checklist should be used in ensuring that all the steps outlined and procedure is followed. All these prevention interventions should be implemented together and not in isolation.
References
Allegranzi, B., &Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), 305-315.
Chen, M., Yu, Q., & Sun, H. (2013). Novel strategies for the prevention and treatment of biofilm related infections. International journal of molecular sciences, 14(9), 18488-18501.
Francolini, I., &Donelli, G. (2010). Prevention and control of biofilm-based medical-device-related infections. FEMS Immunology & Medical Microbiology, 59(3), 227-238.
James, M. T., Conley, J., Tonelli, M., Manns, B. J., MacRae, J., &Hemmelgarn, B. R. (2008). Meta-analysis: Antibiotics for Prophylaxis against Hemodialysis Catheter–Related Infections. Annals of internal medicine, 148(8), 596-605.
Labeau, S. O., Vandijck, D. M., Rello, J., Adam, S., Rosa, A., Wenisch, C., …&Dimopoulos, G. (2009). Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses. Critical care medicine, 37(1), 320-323.
Lok, C. E., &Mokrzycki, M. H. (2011). Prevention and management of catheter-related infection in hemodialysis patients. Kidney international, 79(6), 587-598.
Marschall, J., Mermel, L. A., Classen, D., Arias, K. M., Podgorny, K., Anderson, D. J., …& Fraser, V. (2008). Strategies to prevent central line–associated bloodstream infections in acute care hospitals. Infection Control & Hospital Epidemiology, 29(S1), S22-S30.
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2013). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ QualSaf, bmjqs-2012.
Mermel, L. A., Allon, M., Bouza, E., Craven, D. E., Flynn, P., O’grady, N. P., …& Warren, D. K. (2009). Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clinical infectious diseases, 49(1), 1-45.
O’grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., … &Raad, I. I. (2011). Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), 1087-1099.
Oliveira, C., Nasr, A., Brindle, M., & Wales, P. W. (2012). Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis. Pediatrics, peds-2011.
Pronovost, P. J., Goeschel, C. A., Colantuoni, E., Watson, S., Lubomski, L. H., Berenholtz, S. M., …&Marsteller, J. A. (2010). Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. Bmj, 340, c309.
Timsit, J. F., Schwebel, C., Bouadma, L., Geffroy, A., Garrouste-Orgeas, M., Pease, S., …& Armand-Lefevre, L. (2009). Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. Jama, 301(12), 1231-1241.
Tong, S. Y., Davis, J. S., Eichenberger, E., Holland, T. L., & Fowler, V. G. (2015). Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clinical microbiology reviews, 28(3), 603-661.
Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Agarwal, R., Williams, K., & Brennan, P. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control & Hospital Epidemiology, 32(2), 101-114.
Zingg, W., Imhof, A., Maggiorini, M., Stocker, R., Keller, E., &Ruef, C. (2009). Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Critical care medicine, 37(7), 2167-2173.
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