Thank you,
Lilia
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Ann Marie J. Frey
Sent: Thursday, February 23, 2006 7:09 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED];
[EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: Re: Needless Connectors & CRBSI
I found that statement in a recent article on Antibiotic Locks....the
article itself is excellent and you can get the full text on Medline.
See below.
anne marie frey
Bestul MB, Vandenbussche HL. Antibiotic lock technique: review of the
literature. Pharmacotherapy. 2005 Feb;25(2):211-27. Review. PMID:
15767236 [PubMed - indexed for MEDLINE]
"Normal skin flora are usually responsible for infecting catheters that
have been in place for less than 10 days, whereas organisms residing in
catheter hubs are most likely to cause infection in catheters that have
been in place longer." 34, 35
34. Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis
and epidemiology of catheter-related infection with pulmonary artery
Swan-Ganz catheters: a prospective study utilizing molecular subtyping.
Am J Med 1991;91:S197-205.
35. Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central
venous catheter-related bloodstream infection by use of an
antiseptic-impregnated catheter: a randomized, controlled trial. Ann
Intern Med 1997;127:257-66.
>>> "Lilia Mullins" <[EMAIL PROTECTED]> 02/22/06 11:49 PM >>>
RE: Needless Connectors & CRBSIDear 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 -----
From: Lynn Hadaway
To: Bev and Tim Royer ; 'Chris Cavanaugh' ; [EMAIL PROTECTED] ;
[EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
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 beS..
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
