|
Dear colleagues, I'm in need of references related
to timing of CRBSI. I remember someone stating those noted within 5 days
of insertion are related to the inserter and after that time the user?
Thanks in advance,
Lilia Mullins, RN, CRNI
Swedish Medical
Center
Seattle, WA
206 215-3211
[EMAIL PROTECTED]
----- Original Message -----
Sent: Tuesday, January 17, 2006 1:07
PM
Subject: RE: Needless Connectors &
CRBSI
I agree that we definitely do not have all the answers and need a lot
more data before any conclusions can be drawn. We do need to make our
colleagues aware of these issues though. As you might have guessed I have some
personal ideas about the causes of this problem.
I strongly believe that this is caused by many factors involving the
nurse and the valve and the patient. The nurses performance can be broken down
into 2 categories - a knowledge deficit and a performance deficit. Last summer
when my father had returned from surgery with a complication, the nurse came
in to inject a dose of IV steroid without wiping the luer connection. I
stopped her and explained my concern. Her response was, "Yes, I hope you knew
that I knew to do that." So she was knowledgeable but was not performing
appropriately.
Then there are those others that do not recognize the need to wipe a luer
connector. Think about what has been (or has not been taught to these nurses).
There has always been a heavy emphasis on wiping a surface when we are
injecting anything - we clean the skin before IM or SC or IV injections along
with the split septum before a blunt cannula is injected. But when we are
connecting luer locking tubing together we do not need to clean that because
the sterile ends are protected with a cover. It is hard for me to imagine that
a nurse can not see that the luer connection of a mechanical valve needs to be
cleaned before use, but apparently this is a bigger problem than we
thought.
Then there are the other issues as Tim described with device design and
patient immune status. Also there is the issue of what the various sales reps
are teaching the nurses. Are any of them telling nurses that a mechanical
valve does not need to be cleaned? I certainly hope not, but this could also
be part of the problem. What are they saying about the frequency of changing
the valves? Do they understand the issues of biofilm that grows in all
needleless connectors?
So we have a long way to go with learning the answers to this issue.
Lynn
At 9:35 AM -0800 1/17/06, Bev and Tim Royer wrote:
My
data suggests that it is probably a multitude of different factors. I
am able to track central lines in the facility and into the outpatient arena
that I am working in.
On
the topic of infection rates - if it was just the valves causing the growing
infection rates then you should a pretty even spread catheter related
blood stream infections throughout the facility. The same valve is
used in all the different areas. One med/surg unit continually has a
higher infection rate including the immune compromised area of our cancer
care unit. Our outpatient population has a low infection rate.
Other med/surg units continually have low infection rates including the
ICUs. If the valve was the sole cause of the increasing infection
rates through out the country then there should be comparable infection rate
throughout. This has lead me to believe that it is NOT
just the valves.
Factors, in my mind, that have influence on rates
Compliance of staff with cleaning and maintaining their central
lines
Valve construction
Surface area within the valve
The outside surface of the valve
Flow path
Is the valve clear so you can see blood in the valve
How valves are cleaned and accessed
How often staff flush valves and the amount flush used
Dedicated IV / PICC Team that maintains the central lines
Patient education and follow-up
Staff education
I
am sure there are other factors involved
We do
need more evidence.
Timothy Royer, BSN, CRNI
Nurse
Manager / Vascular Access / Diagnostic Service
VA
Puget Sound Health Care System
Seattle / Tacoma,
WA
From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of Chris Cavanaugh
Sent: Tuesday, January 17, 2006 3:37
AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc:
[EMAIL PROTECTED]
Subject: RE: Needless Connectors &
CRBSI
Sorry, just have to jump in on this one, my impressions from what I
heard at AVA was that there IS evidence. Facilities that used
mechanical valve adaptors saw their CRBSI go up, and returned to lower
numbers after they returned to split septum systems. That was the jist
of both Dr. Maki and Jarvis's statements. The manufactures like to
spread the 'clinician care' angle, but that does not seem possible when it
is so many facilities having the same problem. The reality is that
germs get stuck in the plunger of some devices, probably not all. And,
when we flush these devices the germs get flushed into the catheter.
This does not happen with a split septum system. There is an easy way
to tell if your particular brand of mechanical valve is guilty of
this---Bug Glo. Drop some Bug GLO on your valve, swab vigorously
with alcohol, assuming best practice, then look at your valve.
Does it still show bug glo or did you get it all off? No manufacture will
allow data to be published stating their valve causes infections, and this
is a lot faster, and safer than a study. Of course, if you have
not seen CRBSIs go up in your institution, it may not be a problem for
you-you may be using one of the good devices. If so, THAT should be
published. Good luck to all----this is a surprising
conclusion. We went needleless for safety, then to mechanical valves
for either positive pressure (a myth) to prevent occlusions or for luer lock
access, never thinking it would lead to another problem, a much more
dangerous problem like increased CRBSIs. I think what this does
show to all of us is that the latest and greatest technology may not
be..
Chris Cavanaugh, CRNI
From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of [EMAIL PROTECTED]
Sent: Monday, January 16, 2006
11:04 PM
To: [EMAIL PROTECTED]
Cc:
[EMAIL PROTECTED]
Subject: Re: Needless Connectors &
CRBSI
Well
Peter you hit the question exactly. Drs Maki and Jarvis did not mention a
specific brand. The word from valve manufacturers seems to be blaming
weaknesses in the fluid path seal that allow liquid contaminates in. I heard
practioners talking about poor staff education and/or compliance with
swabbing as a possible cause.
But
truly we don't know that there is a problem. There was no data given as to
type of valve or how it was used or how staff was educated. There was no
data about a trailing a different valve to see if there was a difference.
and no mention was made as to the reeducation of staff and a trail to follow
that.
So I
feel we have many more questions to answer before we start tossing our
valves in the can. But certainly it is interesting and worthy of note. I
hope that everyone will begin taking a close look at the numbers in their
facilities. Perhaps a few quick small trials to see if any trends
emerge.
Tony
In a
message dated 1/15/2006 8:14:56 P.M. Central Standard Time,
[EMAIL PROTECTED] writes:
Thank you Tony for
keeping us all up to date with the conference!! A question though is
burning in my mind. I don't recall, from the disscussion we had on the
list this spring/summer, about a brand specific needless
connector being responsible for for the increase in CRBSI. So could you
please tell us which connector(s) are in question? What is the reason
that belies a particular valve design, that makes it prone to
causing CRBSI?
Peter Marino RN
BSN
----- Original
Message -----
From: [EMAIL PROTECTED]
Date: Sunday,
January 15, 2006 12:06 am
Subject: AVA
conference, DAY 3"The topic was needleless connectors. They discussed the
qualities of a needleless device that would contribute to maintaining a
safe fluid pathway. The premise is that the association of increased
catheter related infections with valves is likely a brand specific problem
and not a wholesale problem of the device category as Drs Maki and
Jarvis's data might have led one to believe."
> Tony West, RN,
CRNI
> Healix, Inc.
> Email: [EMAIL PROTECTED] or
[EMAIL PROTECTED]
> SMS: [EMAIL PROTECTED]
>
Cell: 214-674-4848
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126
Main Street, PO Box 10
Milner, GA
30257
http://www.hadawayassociates.com
office
770-358-7861
|
