Preventable nosocomial infections

As from today Medicaid stop reimbursement for some reasonably preventable nosocomial infections. This article is another that describes the impact of this legislation.

Graves, N. and McGowan, J.E. (2008) Nosocomial Infection, the Deficit Reduction Act, and Incentives for Hospitals. JAMA. 300(13), p.1577-1579.

First 150 words of the article

For every 100 patients admitted to US hospitals in 2002, 4.5 patients developed a nosocomial infection. On October 1, 2008, the Centers for Medicare & Medicaid Services (CMS) will stop reimbursement to hospitals for the cost of treating nosocomial catheter-associated urinary tract infections, vascular catheter-associated bloodstream infections, and surgical site infections following certain elective procedures, including mediastinitis, certain orthopedic surgeries, and bariatric surgery. This regulation arises from the Deficit Reduction Act, signed by the president on February 8, 2006. The goal is to reduce the increases in Medicare and Medicaid spending by stopping payments for conditions that result in the assignment of a higher-cost diagnosis related group and, in the opinion of the regulators, are “reasonably preventable” by the application of evidence-based guidelines.

Intraosseous device wins award

Vidacare Corp., the maker of the EZ-IO medical device, beat out 700 other entries to win The Wall Street Journal’s Eighth Annual Innovation Award Competition. San Antonio-based Vidacare’s EZ-IO was named the sole winner in the overall Gold category of the competition as well as the winner in the medical device category.

Vidacare developed the EZ-IO device in conjunction with the University of Texas Health Science Center at San Antonio. The company specializes in developing, manufacturing and marketing advanced intraosseous (through-the-bone) access technology.

“We are extremely grateful to the judges of The Wall Street Journal Innovation Awards, an established and well-respected competition, for recognizing our intraosseous technology as outstanding,” Vidacare CEO Phil Faris says. He adds “We have worked hard to bring this innovative, emergency solution to both the pre-hospital and hospital communities, so we’re extremely pleased by the market and technology validation represented with this award.”

Click here for the full story.

 

Cardinal spinoff company

Cardinal Health Inc. said Monday that it is spinning off its tech-focused clinical and medical products businesses into a separate public company in a move that will affect Cardinal’s 80-employee Creedmoor operation.

The Granville County facility manufacturers components as part of Cardinal’s intravenous infusion business, which will become part of the new company. The new company will be based in San Diego and led by Cardinal Vice Chairman David Schlotterbeck. He joined Cardinal in 2004, when the company bought Alaris Medical Systems, where he was president and CEO.

Cardinal expects the spinoff to be complete by mid-2009.

Click here to read the full story.

 

Antimicrobial needlefree

Baxter Healthcare Corporation today announced that it received 510(k) clearance for expanded labeling for the first antimicrobial needleless intravenous (IV) connector, V-Link Luer-activated device (LAD) with VitalShield protective coating.

Launched earlier this year, V-Link with VitalShield has now been shown to kill at least 99.99 percent of six common pathogens known to cause catheter-related bloodstream infections. The U.S. Food and Drug Administration (FDA) cleared expanded labeling for V-Link with VitalShield based on V-Link’s ability to combat three additional pathogens: vancomycin-resistant Enterococcus faecalis (VRE), Escherichia coli (E. coli) and Staphylococcus epidermidis (coagulase negative). These three pathogens improve upon the previously cleared labeling, which included methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Enterobacter cloacae.

Click here for the full story on iStoclAnalysist.

Click here for the V-Link product page.

Intraosseous for resuscitation

Medgadget report on the fast1 intraosseous infuson system, reporting that “If the military medics and physicians I work with are right (and I think they are), Pyng is certainly living up to their goals and has become a routine lifesaver in Afghanistan and Iraq”.

Click here for the full story on medgadget.

Click here for the Fast1 website.

Click here for the Fast1 training manual.

 

 

IV safety boosted by grant

Sebasticook Valley Hospital has received a $50,000 grant to bolster its management of medications and patient safety.

The grant is from the Maine Health Access Foundation, a health care organization that provides $5 million in grant and program funding each year. The hospital plans to use the grant for a Barcode Medication Administration Program. The automated system uses barcodes for packaging, storing, tracking, and distributing medications.

Click here for the full story.

Dual syringe technology

Sagent Pharmaceuticals, Inc., a privately-held specialty pharmaceutical company, recently announced the acquisition of Infusive Technologies’ proprietary, patented, multi-chamber, sequential dose syringe technology.

Sagent’s innovative, dual-chamber syringe enables the sequential administration of two separate intravenous (IV) medications with a single syringe push, thereby replacing two syringes with one. The benefits of this single delivery capability include increasing the speed and ease of drug administration; reducing risk of hospital acquired infection by reducing the number of connections; lowering the risk of drug administration or sequence errors, and quicker delivery of emergency medicines requiring an immediate sequential flush. The unique dual-chamber syringe can accommodate lyophilized, powder or liquid formulations in the front chamber combined with diluents, saline or heparin flush in the rear chamber.

Click here for the full story.

Click here to view the syringe animation.

Safety syringe company report

The annual report of the Australian IV safety company Medigard has just been published. It makes an interesting read as it helps to explain the complexities of product development of safety syringes and needlefree device products. These issues are explained in the product development section of the document on page 6 (example below):

“The fine tuning of the syringe design which was the focus of the past year has been completed and the result is an inexpensive, technically superior syringe that operates with vacuum and not a spring or sheath. Ease of use has been commented by all those who have trialed the product and its activation effort is significantly less than competitors’ spring products. That competitive advantage is strengthened by a lower cost to produce, a lack of aerosoling and the advantage of interchangeable needles.  

The next steps for the syringe will be the preparation and submission of an application to the FDA. This will be preceded by relevant focus groups and simulated clinical trials. There is strong interest in the syringe and recognition that it is a leading edge product that fills the current and future market need – a reliable, cheap, safe and user friendly syringe that automatically retracts with no dangerous spray and allows the interchangeability of needles”. 

Click here to view the full document. 

Needlestick leads to fine

OSHA has cited Allcare Dental for alleged willful and serious violations of occupational health standards at its Nashua, N.H., dental office after an employee suffered a needlestick injury. The office faces $76,500 in proposed fines. OSHA’s inspection found that the office did not provide the injured employee with no-cost, post-exposure medical evaluation and follow-up, and did not have the blood of the source individual tested, as required under OSHA’s bloodborne pathogens standard.

In addition, the office’s training program did not include the proper method of removing the capped needle from a syringe, did not explain procedures to be followed in the event of an exposure, and did not provide an opportunity for employees to ask questions about the training. The office’s exposure control program also was incomplete and not updated annually, OSHA said. Finally, the office did not use needles with engineered safety devices for user protection.

Click here for the full story.

Prevention of line sepsis

Roundtable Summit to Formulate Recommendations for the Prevention of Line Sepsis with take place October 3rd 2008. Delegates will include representation from  Association for Professionals in Infection Control and Epidemiology (APIC), The Leapfrog Group for Patient Safety, University HealthSystem Consortium and Allegheny Health System.

“A Leadership Strategy for the Prevention of Line Sepsis” roundtable summit, supported by an educational grant from Cook Medical, provides a forum to develop clear recommendations for patients and the healthcare community to follow to prevent line sepsis. The summit will engage healthcare providers across disciplines, government agencies and constituency groups in an educational dialogue on amending behaviors to prevent line sepsis, while also empowering hospitals and patients with information regarding infection and prevention practices.

Click here for more.

Joint commission suggest ID caution

The new color-coding of ID bracelets has been quickly embraced by at least 20 states and endorsed by the American Hospital Association, the purple bands, typically embossed with the letters D.N.R. to reinforce the message, are meeting with some resistance.

The nation’s leading hospital-accreditation agency, known as the Joint Commission, has expressed caution about the new system, citing concerns about branding patients by their end-of-life choices, or inadvertently broadcasting those choices to family and friends who have not been consulted.

The commission also said that children who do not understand the system had been prone to trade the wristbands like baseball cards.

Click here for the full story.

 

IVTEAM discussion list

I would like to take this opportunity to say a very big thank you to the hundreds of IVTEAM members who subscribe to our email updates. I’m sure its of no surprise that you are part of a truly International IV community. To further benefit your membership, IVTEAM have launched a free email discussion list. The IVTEAM discussion list is moderated, private and secure.

The IVTEAM discussion list is part of the Internet’s leading online IV network focused upon the professional discussion of IV care issues. Subscribing to the IVTEAM discussion list is FREE. Please sign up and support your favorite IV online community.

To subscribe to the discussion list please follow the link http://discussion.ivteam.com/listinfo.cgi/ivteam-ivteam.com

Intravenous fluids infected

A doctor from a team investigating the weekend deaths of 13 newborns at a hospital in western Turkey said Monday that the deaths were a result of an infection spread by IV treatment, the private Dogan news agency reported. The babies — all of them premature — died late Saturday and early Sunday at Izmir’s Tepecik hospital.

It was the second such incident in Turkey in three months.

In July, more than 27 newborns died of an infection at a hospital for high-risk births in the capital, Ankara. Government-appointed doctors investigating the deaths said a staff shortage had increased the risk of infection.

Recep Ozturk, a doctor at Istanbul’s Cerrahpasa University Hospital, said preliminary results of the investigation indicated that an infection caused the latest deaths, Dogan reported. Ozturk, who spoke on behalf of the group of doctors investigating the case, said the babies were infected following IV treatment. He said the infection appeared to be spread by intravenous solution, Dogan reported.

Click here for the full story on Associated Press.

Update 6th October 2008.

Struck off over sharps disposal

A 26 year old registered nurse from Welling, Kent has been struck off the Nursing and Midwifery Council Read more

Central line bloodstream infection

Ranasinghe et al (2008) describe that healthcare worker education and training are essential to create standardization of aseptic care. They also state that continuous surveillance is necessary for identifying lapses in infection-control practices.

Ranasinghe, J.S., Lee, A.J. and Birnbach, D.J. (2008) Infection associated with central venous or epidural catheters: how to reduce it? Current Opinion in Anaesthesiology. 21(3), p.386-90.

Abstract:

PURPOSE OF REVIEW: Central venous catheters are a leading source of nosocomial bloodstream infection with an estimated 10% mortality. Infection associated with epidural catheterization is an uncommon but devastating complication. Diagnosis of spinal epidural abscess requires a high index of suspicion and imaging techniques such as MRI. Early diagnosis and treatment will minimize permanent damage, but primary prevention should be the aim, which depends on proper patient evaluation and use of full aseptic precautions. RECENT FINDINGS: Recent studies suggest that epidural infection is no longer as rare a complication as once thought and may be increasing. It is not clear whether this increase is related to an increase in reporting, an overall increase in the total number of epidurals (especially extended use) being performed, or a true increase in infection rate. Implementation of multistep prevention programs has been shown to decrease central venous catheter-related bloodstream infection rate. Antiseptic or antibiotic-impregnated central venous catheters are effective in decreasing central venous catheter-related bloodstream infections. SUMMARY: Healthcare worker education and training are essential to create standardization of aseptic care. Continuous surveillance is necessary for identifying lapses in infection-control practices.

 

Venipuncture pain in children

Spagrud et al (2008) examine pain and distress from needles in children undergoing blood sampling from central external venous lines, internalized ports and peripheral venipuncture. 

Spagrud, L.J., von Baeyer, C.L., Ali, K., Mpofu, C., Fennell, L.P., Friesen, K. and Mitchell, J. (2008) Pain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access. Journal of Pain & Symptom Management. 36(2), p.173-184.

Abstract:

This study examined pain and distress from needles in children undergoing blood sampling as a function of adult-child interaction and type of venous access (i.e., central external venous lines, internalized ports, or peripheral access via venipuncture). Participants were 55 pediatric oncology patients, aged 3-18 years, who were undergoing routine blood work. Pain ratings were obtained using the Faces Pain Scale-Revised (FPS-R) and conversation during the procedure was audio taped for coding using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Children’s ratings of pain using the FPS-R were similar in the port (M=2.57/10, standard deviation [SD]=3.46) and peripheral (M=2.56/10, SD=3.24) groups, despite the fact that most children with internal ports were given a topical anesthetic. Similarly, there were no differences between port and peripheral groups in rates of child coping or distress, or parent and nurse observations of child pain. As would be expected, external line access was not associated with pain or distress, even among very young children, suggesting that they appropriately understood the pain rating scale. Results of the transcribed CAMPIS-R data indicate that the influences in adult-child interaction are bidirectional. Support was found for the well-established positive relationship between child distress and adult reassurance and empathy. Implications for intervention and selection of central venous access devices are discussed.

 

Novel therapeutic drug monitoring

Cranfield University and Sphere Medical Holding PLC are to receive an investment of £322,000 from the Technology Strategy Board to develop a novel drug sensor which will improve the care of critically ill patients by ‘personalising’ their medication.                                                       

Each patient’s unique combination of characteristics such as weight, age and gender will affect how drugs perform therapeutically in the body. Therefore it is important that clinicians have the appropriate tools to customise a patient’s medication and achieve optimum uptake.

To meet this need, the industrial-academic team will spend the next few years developing a disposable sensor that can measure drug concentration, detect changes as they happen and provide early detection of any faults in the drug delivery system.

Click here for the press release.

 

Huber needle safety

This monograph describes some of the recent recommendations for safe handling of hazardous drugs as well as safety precautions from needlestick injuries in chemotherapy administration.

Nurses administering chemotherapy are at risk for injuries caused by Huber needles. According to the Exposure Prevention Information Network (EPINet), rebound needle injuries are on the rise and pose a high risk for pathogen transmission. The prevalence of vascular access devices and hazardous drugs used in the administration of chemotherapy makes this group of healthcare workers a very special case. Safe and effective use of vascular access devices (VAD) and the safe handling of hazardous drugs is the purpose of this publication — Protecting the Healthcare Worker: Focus on Oncology.

Click here for the monograph.

Intravenous device MRSA reduced

The latest quarterly figures on MRSA bloodstream infections, published by the Health Protection Agency today, show that the number of MRSA infections has fallen by 57% compared to the base level in 2003/4 when the target was set.

Mike Farrar, Chief Executive of NHS North West, said: “We are taking healthcare associated infections very seriously. These figures show great progress and that is a tribute to the hard work of NHS staff coupled with the introduction of new products and technologies. We have also successfully recruited new hospital matrons to ensure standards are met.

One of the technologies being evaluated is a skin disinfecting product for use when inserting intravenous lines. Also, the Royal Liverpool and Broadgreen University Hospitals NHS Trust, has formed a partnership with John Hopkins Hospital in Baltimore, USA. John Hopkins Hospital has eradicated all blood borne infections caused by intravenous lines. The hospital has been working with the Strategic Health Authority and Department of Health, along with representatives from Aintree Hospitals and Liverpool PCT, to learn good practice from John Hopkins.

Click here for the full story.

 

CRBSI prevention program

Teleflex Medical today announced the launch of an infection-protection speaker program that will take Read more

Hospitals report on CRBSI

San Juan Regional Medical Center is one of six New Mexico hospitals that are participating in the state Department of Health’s healthcare-associated infection pilot project. The hospitals will report data about healthcare-associated infections to the department, with the goal being reduction of healthcare-associated infections and their adverse effects on patients.

The six hospitals began reporting “central-line associated” bloodstream infections in July. Those are infections resulting from having an intravenous catheter and that can lead to bacteria invading a patient’s bloodstream if the IV is not managed properly.

Click here for the full story.

BBraun IV safety newsletter

This recently published BBraun IV safety newsletter is full of articles and features such as the article by Dr Mike Ashton, Consultant Gastroenterologist, at Chesterfield Royal Hospital, who highlights that even after 36 years of practice, accidental needlestick injuries can happen. 

Paula Ingram discusses her experience with NHS Lothian after the benefits of changing from a Teflon catheter to a Polyurethane catheter were recognised. In addition, Paula discovered that they could also protect staff by introducing a safety cannula.  

Finally Catherine Briggs, Anne-Marie Brompton and Lyndsey Moulding from the Mid Yorkshire NHS Trust write on the success of introducing an IV safety cannulation pack.

Click here to view the full BBraun IV safety newsletter.

Hepatitis C closes dialysis centre

A New York dialysis center was shut down by the state Health Department and hundreds of patients were urged to be tested after at least one patient contracted hepatitis C from treatment at the center. 

The Health Department notified 657 patients of the Life Care Dialysis Center that they should be tested for both hepatitis B and C strains, as well as HIV. Nearly 200 patients were forced to be transferred to other centers to continue dialysis. 

After a week-long inspection of the center, Health Department officials said they uncovered poor infection control practices, including “blood on the treatment chairs and dialysis machines, lack of proper hand hygiene, and inadequate disinfection of equipment,” according to a release. 

click here for the full story.

 

Court orders transfusion

A woman who refused blood transfusions after attempting suicide was treated in hospital by direction of the High Court. Mr Justice Daniel O’Keeffe heard that the woman, who cannot be identified for legal reasons, was recovering following treatment in a Dublin hospital.

Ms Eileen Barrington, counsel for the Health Service Executive (HSE), said the court, in a late sitting on Friday last, had authorised staff at the hospital where she was being treated to administer all medically appropriate treatment. This included liberty to transfuse up to four litres of blood if necessary to safeguard her life, health and general welfare.

Click here for the full story.

 

Home parenteral nutrition

The Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) have published evidence based guidelines for home parenteral nutrition (HPN).

Gillanders, L., Angstmann, K., Ball, P., Chapman-Kiddell, C., Hardy, G., Hope, J., Smith, R., Strauss, B. and Russell, D. (2008) AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand. Nutrition. 24(10), p.998-1012.

Abstract:

OBJECTIVE: Evidence based guidelines for home parenteral nutrition (HPN) were commissioned by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) and developed by a multidisciplinary group. The guidelines make recommendations in four domains: patient selection, patient training, formulation and monitoring regimens, and preventing and managing complications. METHODS: The Appraisal of Guidelines Research and Evaluation guideline process was used to focus questions and identify evidence by systematic literature reviews of meta-analyses and randomized control trials in the Cochrane Library, Medline, Embase, and Cinahl to mid-2007. Where no randomized control trial evidence was found, the search was broadened to observational studies and expert opinion from related national and international guidelines as assessed by a validated appraisal process. RESULTS: Selection of patients must assess individual risk/benefit and medical ethics. Patient training should be undertaken within a structured framework. Access devices should be selected for lowest risk of complications, including occlusion, sepsis, and breakage and be managed by early diagnosis and treatment. HPN should be formulated according to individual patient requirements by professionals with relevant skills and training. Pumps and ancillary products should conform to quality standards. Other intravenous medications may be prescribed provided these are reviewed for compatibility and effects on metabolic status. CONCLUSION: Overall there is a lack of randomized control trials to provide high-quality evidence-based guidance but graded recommendations can be made. Multidisciplinary teams in centers with HPN management expertise are required for optimal care. This guideline should improve outcomes and quality of life for HPN patients in Australia and New Zealand.

 

Zuragen Injection for CRBSI

Ash Access Technology, Inc. announced that the last patient enrolled in the AZEPTIC Trial for Zuragen(TM) Injection has completed the study. The AZEPTIC Trial was a randomized study evaluating the efficacy and safety of Zuragen(TM) Injection in reducing the incidence of catheter-related bloodstream infection (CRBSI) in patients requiring the use of a central venous catheter (CVCs) for hemodialysis. The trial enrolled over 400 patients at 25 dialysis facilities across the United States. Portions of the AZEPTIC Trial were financed through grants awarded by the National Institutes of Health (NIH) and the Indiana 21st Century Technology Fund.

Zuragen(TM) Injection is a non-antibiotic, antimicrobial / antithrombotic therapy that is administered into a patient’s catheter at the conclusion of each hemodialysis session. The product’s unique components have demonstrated a novel synergy which has led to significant and rapid efficacy against a broad spectrum of bacteria and fungus as well as complete elimination of biofilm in pre-clinical studies.

Click here for the full story on Marketwatch.

Reducing drug errors

Staff at Little Company of Mary Hospital in Torrance have installed a new computer system they hope makes human error less likely.

The $2.5 million system includes three components: so-called smart pumps that don’t allow nurses to program the wrong dosage in intravenous machines; a bulky robotlike machine that dispenses common drugs in the pharmacy with minimal human handling; and a new bar-coding system that they hope will prevent prescription mistakes.

Click here for the full story.

 

Transporting blood samples

Technology developed for war has been turned to the saving of lives. Engineers have converted uncrewed military aircraft into robotic carrier pigeons that could ferry medical samples from remote regions to labs for testing.

The UAVs (uncrewed aerial vehicles) are designed to be launched from clinics and pilot themselves along a pre-programmed route to the nearest lab, using GPS and microelectronic gyroscopes to guide them.

The team are waiting for authorisation from the South African Civil Aviation Authority to begin trials transporting samples from a real clinic.

Read the full story on New Scientist.

Needlestick injuries

The American Nurses Association (ANA) have announced the findings of the 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries, an independent nationwide survey of more than 700 nurses.

According to the latest research, nearly two-thirds (64 percent) of U.S. nurses say needlestick injuries and blood borne infections remain major concerns, and 55 percent believe their workplace safety climate negatively impacts their own personal safety. 

Sixty-four percent of nurses report being accidentally stuck by a needle while working.  This mirrors findings from the 2006 Study of Needlestick Injuries and Safety Devices.  Although in 2008, 75 percent report being stuck by a standard (non-safety) syringe, and in 2006, the figure was 85 percent.  

When asked how nurses attained their most recent needlestick injuries, the top three responses include: while giving an injection (28 percent); before activating the safety feature (19 percent); and during the disposal of a non-safety device (19 percent).

Click here for the report.

 

Sven-Ivar Seldinger (1921-1998)

The Seldinger name is immortalized throughout healthcare due to his identification of the catheterization technique known around the world as the Seldinger technique. But who was Seldinger?

Sven-Ivar Seldinger was born in the small town of Mora in Sweden in 1921. He was educated in local schools before studying medicine at the Karolinska Institute in Stockholm. In 1975, he received the Valentine award from the New York Academy of Medicine; he held honorary membership of the Swedish Association of Medical Radiology and the German Roentgen Association.

Seldinger died in 1998, aged 71, in his home town of Mora.

Click here for his biography and bibliography.

 

Ethanol locks to prevent CRBSI

The use of 70% ethanol locks to prevent catheter-related bloodstream infections in children is reviewed in this  study by Mouw et al (2008).

Mouw, E., Chessman, K., Lesher, A. and Tagge, E. (2008) Use of an ethanol lock to prevent catheter-related infections in children with short bowel syndrome. Journal of Pediatric Surgery. 43(6), p.1025-1029.

Abstract:

BACKGROUND: Children with short bowel syndrome (SBS) requiring central venous catheters (CVCs) may experience frequent catheter-related infections (CRIs). Treatment strategies include antibiotic- and ethanol-containing locks, with CVC removal if the CRI cannot be cleared. Ethanol lock therapy has been reported for CRI treatment in children but not for CRI prevention. METHODS: Medical records of children with SBS receiving cycled home parenteral nutrition via a silicone CVC and who received a daily 70% ethanol lock at some time during their therapy were reviewed retrospectively. MAIN RESULTS: Ten patients had 26 CVCs for a total of 3556 catheter-days and received a daily ethanol lock for 4 to 14 hours during a total of 3018 catheter-days. Before ethanol lock therapy (n = 5), there were 6 CRIs in 538 catheter-days (rate, 11.15 per 1000 catheter-days). During ethanol lock therapy in the same 5 patients, the CRI rate decreased to 2.06 per 1000 catheter-days (4 CRIs in 1936 catheter-days). In the 5 patients with no ethanol lock-free period, the CRI rate was 1.85 per 1000 catheter-days. Overall, CRI rate with ethanol lock therapy was 1.99 per 1000 catheter-days (2 CRIs in 1081 catheter-days). Four patients developed 6 CRIs during ethanol lock therapy. Four of these CRIs were cleared with systemic anti-infective and ethanol lock therapy; 2 CVCs were removed owing to infection. No adverse reactions were reported during ethanol instillation. CONCLUSION: A daily 70% ethanol lock for CRI prevention was safe and effective in a series of 10 patients with SBS.

INS webinar

With new federal regulations limiting reimbursements for hospital-acquired infections (HAIs) looming on the horizon, B. Braun Medical Inc., the Infusion Nurses Society (INS), and the Massachusetts Hospital Association (MHA), will host a Webinar series in September to equip nurses and hospital managers with best practices that can help prevent the spread of infections in their facilities.

The two part-Webinar series, titled “New CMS Ruling: The Impact on Health, Hospitals, and Infusion Therapy,” is scheduled for September 4 and September 16 and comes in response to a Centers for Medicare & Medicaid Services (CMS) rule that will take effect on October 1. The rule prohibits payment to hospitals for care required to treat several types of HAIs.

Click here for more information.

Accelerated seldinger technique

The core management team from Venetec International has reunited at Access Scientific, Inc. to launch The Wand(R) family of Micro-Access Safety Introducers.

The Wand combines all components of the Modified Seldinger Technique into a unitary device designed for faster, safer, simpler over-wire vascular access. With built-in passive needlestick safety and patient-safety features such as the “fast flash,” self-aspirating technology, The Wand enables clinicians to perform the Accelerated Seldinger Technique — the ultimate refinement in vascular access technology.The Wand is currently in development phase and has not yet received FDA 510(k) clearance. Access Scientific expects to introduce its first product, the Micro Access Wand, in fall 2008. At least two additional products, the PICC Wand and the PIV Wand, will be launched in 2009.

Click here for the full story on Marketwatch.com

PICC placement kit

Navilyst Medical, the manufacturer and global marketer of vascular access and fluid management medical devices, has launched new products just four weeks after the company’s introduction of its new corporate brand following the previously announced divestiture from Boston Scientific.

They are:

• An Expanded PICC Convenience Kit program
• A dual-safety EZ Huber® Infusion Needle Set
• New Xcela® Power Injectable Ports

The two new devices and enhanced PICC Convenience Kitting offerings expand Navilyst Medical’s popular vascular access device product lines and can contribute to a hospital’s infection prevention program.  The products are designed to contribute to a hospital’s compliance with OSHA regulations, CDC guidelines, as well as recently announced Joint Commission Hospital Patient Safety Goals.

Click here for the full story.

Intravenous therapy at hospice

Cancer patients will now be able to receive specialist IV treatment in the comfort of a Worcester (UK) hospice. In a partnership between St Richard’s Hospice and Worcestershire Royal Hospital, more cancer patients will receive specialist intravenous treatments from the charity.

Patients can be seen for intravenous therapies, including infusions for bone pain and blood transfusions.

Worcestershire Royal Hospital matron Glenis Adams said: “We will be able to offer more treatment for patients by transferring care to St Richard’s for those patients who wish to attend the hospice.

Click here for the full story.

 

IV tubing holder

Lenore Henning, a registered nurse, invented a product to hold and organize medical tubing. The device, named The Beata Clasp, keeps tubing in place and also helps patients to become involved in their care.

DOTmed.com report that Henning’s invention has the ability to hold tubing in place on the bedrail and organize lines so that they can be easily traced from the patient to the source by medical staff. According to the Emergency Care Research Institute (ECRI), clean tracing of tubing is the best way to prevent potentially deadly tubing misconnections. 

Click here for the full story.

Purple glove syndrome

According to its quarterly report, the Food & Drug Administration (FDA) is investigating instances were Phenytoin injections led to a disorder known as Purple Glove Syndrome.

In its report, the FDA did not say how many cases of phenytoin-related Purple Glove Syndrome it was investigating. But a 1998 study conducted by researchers at the Mayo Clinic found that of 152 patients receiving intravenous Phenytoin, 9 (about 5.9%) developed Purple Glove Syndrome. The study also found that the disorder was more likely to affect the elderly, and people who received more than one dose of Phenytoin.

Click here for the full news item on Newsinferno.com

inadvertent arterial cannulation

Diana Levine was inadvertently administered Phenergan into an artery. Within weeks, doctors amputated her forearm and hand. The drug label had warned that hitting an artery could cause irreversible damage, but it did not specifically direct physicians to avoid delivering the drug with intravenous push injection — rather than free-flowing IV infusion.

Levine sued, charging that, because the pharmaceutical company had known for decades that using IV push to inject Phenergan directly into a vein creates avoidable risk, it should have added specific instructions on its label barring the practice.

The court awarded Levine $6.8 million. However, the U.S. Supreme Court will hear an appeal on Nov. 3 2008.

Click here for the full story.

IV catheter obturator alert

Due to a manufacturing problem, there may be cracks and holes in the packaging of some obturators for Venflon™ cannulae, which could compromise sterility. The obturator protects the inner lumen of the catheter from coagulation and thrombus formation after discontinuation of infusion.

The device in question is Venflon™ IV cannula obturator manufactured by BD. Product code numbers 394252 and 394253. Various lot numbers. 

Click here for the MHRA alert.

Clean hands save lives

On the 2nd September 2008 the National Patient Safety Agency (NPSA) has reissued its Alert on hand hygiene to reinforce its importance as a significant factor in reducing infection in health.

The guidance has been produced by the NPSA and applies to all NHS staff in England and Wales who have direct contact with patients.

 Speaking of the “Clean Hands Save Lives” alert, Martin Fletcher, Chief Executive of the NPSA said:

“The patient safety alert highlights the need for all healthcare staff to clean their hands at the point of care – that is, the patient’s immediate environment where treatment takes place – as this is when there is the greatest risk of transferring infection. In hospitals, the point of care will usually be around the patient’s bed, while in other settings this could be a treatment room, cot, chair, ambulance or the patient’s home.”

The NPSA recommends the use of alcohol handrub only on non-soiled hands as it is effective and quick to use. If hands are visibly dirty or if the patient has been experiencing vomiting or diarrhoea then the healthcare staff must wash their hands with liquid soap and water.

From 1 November 2003 to 15 July 2008 there have been 379 patient safety incidents reported to the NPSA involving alcohol handrub. Although the majority of these resulted in no or low harm the NPSA believes that these risks could be managed if NHS trusts followed their recommendations on where the handrub dispensers should be placed.

“The National Patient Safety Agency has always said that alcohol handrub is most effective when the dispensers are installed at the point of care as this is when staff should be cleaning their hands to avoid spreading infection,” Martin Fletcher said. “In most cases this is at the foot of the patient’s bed, their bedside locker or their chair. We recommend staff use personal dispensers, particularly if they treat children or mental health patients, as this further minimises risk. Hospitals that install handrub dispensers away from the point of care, including along corridors or at ward entrances, must take the necessary safety and storage precautions”.

To coincide with the alert, which replaces guidance from 2004 and now includes best practice guidelines set by the World Health Organisation (WHO), the NPSA is hosting a summit today (2 September) at the UCL Institute of Child Health. The summit will highlight issues such as risk management and the international standard for hand hygiene products through a series of presentations by the WHO World Alliance for Patient Safety, Health Protection Agency, Department of Health and Welsh Assembly Government.

Local organisations remain responsible for making sure their healthcare staff comply with hand hygiene procedures, and the NPSA will review how the alert has been put into practice in April 2009.

View the alert here.

Chlorhexidine antisepsis

Lim and Kam (2008) review the pharmacology, microbiology, clinical applications and adverse effects of chlorhexidine.

Lim, K.S. and Kam, P.C. (2008) Chlorhexidine-pharmacology and clinical applications. Anaesthesia and Intensive Care. 36(4), p.502-12.

Abstract:

Chlorhexidine is a widely used skin antisepsis preparation and is an ingredient in toothpaste and mouthwash. It is an especially effective antiseptic when combined with alcohol. Its antimicrobial effects persist because it is binds strongly to proteins in the skin and mucosa, making it an effective antiseptic ingredient for handwashing, skin preparation for surgery and the placement of intravascular access. Catheters impregnated with chlorhexidine and antimicrobial agents can reduce the incidence of catheter-related bloodstream infections. Contact dermatitis related to chlorhexidine is not common in health care workers. The incidence of contact dermatitis to chlorhexidine in atopic patients is approximately 2.5 to 5.4%. Acute hypersensitivity reactions to chlorhexidine are often not recognised and therefore may be underreported. This review discusses the pharmacology, microbiology, clinical applications and adverse effects of chlorhexidine.

Biofilm and CRBSI

Raad et al (2008) describe the scientific efforts have been directed toward inhibiting bacterial growth by disrupting surface adherence and preventing biofilm production. 

Raad, I.I., Fang, X., Keutgen, X.M., Jiang, Y., Sherertz, R. and Hachem, R. (2008) The role of chelators in preventing biofilm formation and catheter-related bloodstream infections. Current Opinion in Infectious Diseases. 21(4), p.385-392.

Abstract:

PURPOSE OF REVIEW: As metallic cations are essential to microbial adherence, biofilm formation, and bacterial growth, efforts have been directed toward utilizing metal-binding chelators that have the capability of inhibiting bacterial growth by disrupting surface adherence and preventing biofilm production. This review focuses on recent advances in the role of chelators in biofilm disruption and prevention of catheter-related bloodstream infections. RECENT FINDINGS: The most important factor in the pathogenesis of catheter-related bloodstream infections is the intraluminal colonization of the central venous catheters through the formation of bacterial biofilm matrix in which microbial organisms embed themselves and eventually become a source of catheter-related bloodstream infections. It has been demonstrated that high-affinity metal-binding chelators including ethylenediamine-tetraacetic acid and citrate have the capacity of inhibiting microbial growth by disrupting surface adherence and preventing biofilm production. Furthermore, ethylenediamine-tetraacetic acid and citrate have been clinically shown to be highly effective and outperform heparin in the prevention and treatment of catheter-related bloodstream infections when used as a component of antimicrobial catheter lock solutions. SUMMARY: It is suggested that the addition of chelators such as ethylenediamine-tetraacetic acid and citrate to antimicrobial lock solutions provides an innovative and superior alternative to heparin lock solution in the prevention and treatment of catheter-related bloodstream infections.

 

AVA conference update

Marketwatch.com have reported that improvements in the prevention of catheter-related infections will be the prime focus at the annual conference of the Association for Vascular Access (AVA) September 11-14 in Savannah, Ga.

The conference comes on the eve of major changes in Medicare that will eliminate payments to hospitals that fail to prevent certain hospital-acquired infections.

Among conference presentations on preventing catheter-related bloodstream infections:

• Allan Morrison, Jr., M.D., will describe the vision of an infection control program that can improve clinical outcomes and decrease infection rates, high-risk antibiotic use, hospital lengths of stay, and mortality.
• Stephen Ash, M.D., FACP, and Deb Richardson, R.N., M.S., CNS, will review current data about the effect of catheter locks or coatings on the infection rates. The speakers will also examine the potential for these technologies to significantly reduce catheter-related infections in the future.
• Kari Love, R.N., B.S., will present a poster to show how use of a closed luer access, split-septum device has eliminated catheter-related bloodstream infections for eight months in an adult medical-ICU population. The device replaced a positive-pressure mechanical valve.

 

 

BBraun silver needlefree

FDAnews announced that BBraun Medical has received 510(k) clearance from the FDA for its silver-impregnated antibacterial luer access device to reduce potential catheter-related bloodstream infections.

The Ultrasite device uses a controlled-release silver ion technology that reduces harmful bacteria, the company said. The product, which will be available later this year, combines needle-free access for reduced needlestick injuries and positive displacement to help minimize catheter occlusions.

Click here to read the FDAnews Device Daily Bulletin Sept. 4, 2008  | Vol. 5 No. 173

Living with a PICC line

This two-stage descriptive study looks at the the views of patients who are living with Peripherally Inserted Central Catheters (PICC).

Molloy, D., Smith, L.N. and Aitchison, T. (2008) Cytotoxic chemotherapy for incurable colorectal cancer: living with a PICC-line. Journal of Clinical Nursing. 17(18), p.2398-407.

Abstract:

Aims. (i) To determine which aspects of living with a peripherally inserted central catheter (PICC) line cause Modified de Gramont (MdG) patients most difficulty. (ii) To explore MdG patients’ views of the PICC-line experience. (iii) To determine if patients view PICC-lines as a benefit or a burden when receiving ambulatory MdG chemotherapy.

Design. A two-stage, descriptive study.

Methods. Phase 1 comprised semi-structured interviews. Phase 2 surveyed the MdG population. Phase 1 interview data informed the Phase 2 questionnaire. The setting was a West of Scotland Cancer Care Centre and the sample was: Phase 1, a convenience sample of 10 MdG patients; Phase 2, 62 consecutive patients.

Results. A response rate of 93·9% for Phase 2. The majority of PICC-line patients held favourable views towards having a PICC-line and adapted well with minimal disruption to daily life. Concerns were evident regarding coping at home with a PICC-line, chemotherapy spillage, dealing with complex information and the responsibility of patients/carers regarding PICC-line management. Patients preferred ambulatory chemotherapy to in-patient treatment.

Conclusions. PICC-lines should be considered for more chemotherapy patients but service development is necessary to ensure individual needs are addressed.

Relevance to clinical practice. Contributes to the PICC-line literature by providing a national patient perspective on a range of daily living activities (DLAs). PICC-line patients prefer out-patient ambulatory chemotherapy rather than in-patient treatment. The longer a patient has a PICC-line, the more able they are to manage activities such as dressing. Concerns remain over chemotherapy spillage, partner/carer responsibility for PICC-line maintenance and the proper balance between required information and what the patient wants to know.

Catheter-related bloodstream infections

This study suggests that the number of lumens and site of access were independent risk factors for the development of Catheter-Related Bloodstream Infections (CRBSI).

Templeton, A., Schlegel, M., Fleisch, F., Rettenmund, G., Schobi, B., Henz, S. and Eich, G. (2008) Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study. Infection. 36(4), p.322-7.

Abstract:

Background  Catheter-related bloodstream infections (CRBSI) are a leading cause of nosocomial infections associated with significant mortality and costs. The objective of this study was to determine the rate of CRBSI in two large Swiss hospitals and to identify risk factors for this condition.

Patients and Methods  During 1 year all central venous catheter (CVC)-inserted in patients admitted for visceral, orthopedic or urologic surgery at the cantonal hospital in St Gallen and cantonal hospital in Chur were included in the study. Catheters were followed for the duration of their insertion. Blood cultures and semiquantitative cultures from catheters were drawn in the presence of local or systemic signs of infection. Primary endpoint was CRBSI defined as definite if (a) the same pathogen grew in at least one blood culture and from the distal segment of the catheter or (b) the same pathogen grew in at least one peripherally and centrally drawn blood culture and the differential time to positivity of central blood culture vs peripheral blood culture was > 120 min. CRBSI was defined as probable if at least one blood culture was positive with a recognized pathogen in the absence of another site of infection. Data were analyzed using univariate and multivariate time-to-event methods.

Results  During the study period, 1,396 CVCs were prospectively studied in 1,162 patients. Incidence density of all CRBSIs (definite n = 29, probable n = 7) was 2.5 (95% CI: 1.8–3.5) per 1,000 catheter-days. The lowest rate of CRBSI was found in subclavian catheters, the adjusted hazard ratio (HR) for jugular catheters was 2.2 (95% CI: 1.1–4.3; p = 0.03) and for femoral catheters 2.9 (95% CI: 0.6–14.4; p = 0.19). Each additional lumen increased the risk (HR = 4.4; 95% CI: 2.5–7.7; p < 0.001), whereas the permanent blocking of additional lumens was protective (HR = 0.3; 95% CI: 0.1–0.7; p = 0.006). The most commonly isolated organism were coagulase-negative staphylococci with a rate of 28%.

Conclusion  Number of lumens and site of access were independent risk factors for CRBSI. The use of catheters with multiple lumens should therefore be restricted as far as possible. If a catheter cannot be removed, the permanent closure of unneeded lumens may reduce the risk of CRBSI.

 

Peripheral cannulation

Researchers from Aberdeen’s Robert Gordon University presented a study at the British Pharmaceutical Conference in Manchester in which they suggested that a third of patients are cannulated unnecessarily.

350 patients entered the study – who were all treated in the acute medical assessment unit of Aberdeen Royal Infirmary, 91% of patients had a short peripheral catheter inserted. But 28% of the cannulae were never used. The researchers also found that in 71% of patient records there was no documentation of a cannula being inserted, while in 57% there was no documentation of it being removed.

The researchers, led by Dr Yash Kumarasamy, said that in many UK hospitals, it has become common practice to insert an intravenous cannula when the patient is admitted, irrespective of need. He said: “We would like to see the introduction of a formal procedure under which hospital pharmacists review patients and their medications and make recommendations to the treatment team about whether or not a cannula is needed.”

Click here for the full story on BBC News.

Needlestick injury survey

The Royal College of Nursing (RCN) are running an online survey to find out peoples experiences of needlestick injuries. The RCN aim to use the results of the survey to help safeguard staff and patients.

The survey should only take a few minutes to complete. When completed forms are submitted you will be able to submit an entry into a prize draw to win a delegate place at an RCN conference of your choice.

Central venous thrombosis

The incidence of PICC- related upper extremity venous thrombosis has been reported to be anywhere between 0% and 56%. This study attempts to suggest that the use of prophylactic anticoagulation may reduce thrombotic risks in PICC’s. The authors also suggest the importance of early ultrasound if thrombosis is suspected.

Paauw, J.D., Borders, H., Ingalls, N., Boomstra, S., Lambke, S., Fedeson, B., Goldsmith, A. and Davis, A.T. (2008) The Incidence of PICC Line–Associated Thrombosis With and Without the Use of Prophylactic Anticoagulants. Journal of Parenteral and Enteral Nutrition. 32(4), p.443-447.

Abstract:

Background: Indications for peripherally inserted central catheters (PICC) for long-term venous access have grown during the last several years. There are various complications associated with PICC lines, a common one being venous thrombosis. This study’s purpose was to determine the incidence of venous thrombosis associated with PICCs with and without prophylactic anticoagulants. Methods: In this observational, prospective, cohort study, patients with PICC lines were evaluated using Doppler ultrasound for the presence of PICC-associated venous thrombosis at 5-7 days and again at 12-14 days after line placement. When present, clinical signs and symptoms of thrombosis were documented. Fifty-six patients were evaluated for the type of anticoagulation used, if any, and other clinical parameters such as smoking, ambulation, and previous surgery. The incidence of thrombus was then calculated for the entire population as well as for specific patient subgroups. Results: Patient age was 55.7 ± 2.6 (mean ± SEM) years, and BMI was 28.2 ± 1.2 (n = 56). There were 38 (67.9%) nonambulatory subjects, 15 (26.8%) smokers, 4 (7.1%) coagulopathic subjects, 2 (3.6%) patients receiving estrogen-containing medications, 25 (44.6%) who had undergone surgery within the past 6 months, and 5 (8.9%) cancer patients. There were 21/56 patients (37.5%) with thrombus. Patients who received anticoagulation had a 22.9% (8/35) incidence of thrombosis, which was significantly less (P < .05) than for those who received no anticoagulant (13/21, 61.9%). Conclusion: The use of anticoagulants for prophylaxis in patients with a PICC line was associated with a decreased rate of associated venous thrombosis.

Electronic care record

GE healthcare have developed an application that integrates clinical and medical device data under one standard platform.

The Centricity Enterprise Monitored Care application helps improve the quality of care by integrating all monitored care information into a single electronic record. The care record will allow data captured from devices such as monitors and ventilators to be displayed alongside data about intravenous medications and fluids, intake & output, laboratory results, and other categories of data for more efficient documentation and interpretation.

Click here for the full story.

Aseptic Non-Touch Technique

We reported in July 2008 that the Aseptic Non Touch Technique implementation team had announced the 1st National Conference on Aseptic Non Touch Technique (ANTT) on the 29th September 2008. This is now sold out. However, this is not all bad news, the team have announced a second date. If you did not manage to book a place on the September conference the team are repeating the conference on the 27th October 2008.

This National Conference for ANTT will present important latest evidence and developments from leading NHS hospitals.

Click here for further information.

Congress on vascular access

The Vascular Access Society have announced the 6th International Congress on Vascular Access. The congress will take place in Rome (Italy) on April 20th to the 22nd 2009.

Click here for more information.

 

Vascular access guidelines

The vascular access society have made available vascular access guidelines. These are aimed mainly at renal medicine. However, topics such as ‘placement and management of a tunneled catheter’, ‘management of central venous obstruction’ or ‘management of tunneled catheter infection’ should all be an interesting read for any intravenous practitioner.

Click here for the full guidelines.

New sharps safety law

ohsonline.com report on a new state law that goes into effect today prohibiting the disposal of home-generated sharps waste in California residents’ trash or recycling containers and requiring that all such waste be transported to a collection center in an approved sharps container. Californians generate an estimated 400 million used sharps each year, many of which are disposed of as household trash.

Click here for the full story.