International Emergency Nursing
Volume 17, Issue 1 , Pages 60-68 , January 2009

The role of nurses working in emergency and critical care environments in the prevention of intravascular catheter-related bloodstream infections

  • Dominique M. Vandijck, (RN, CCRN, MSc, MA) (PhD Candidate)

      Affiliations

    • Faculty of Medicine and Health Sciences, Ghent University, Intensive Care Department of the Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
    • Corresponding Author InformationCorresponding author. Tel.: +32 9 332 50 47; fax: +32 9 332 49 95.
  • ,
  • Sonia O. Labeau, (RN, MNSc) (PhD Student)

      Affiliations

    • Faculty of Healthcare, Ghent University College, Keramiekstraat 85, 9000 Ghent, Belgium
    • Tel.: +32 9 321 21 11; fax: +32 9 220 17 26.
  • ,
  • Mariona Secanell, (RN) (Professor)

      Affiliations

    • Joan XXIII University Hospital, Pere Virgili Health Institute, University of Rovira and Virgili, CIBER, Enfermedades Respiratorias, Department of Intensive Care, Tarragona, Spain
    • Tel.: +34 977 29 58 18; fax: +34 977 29 58 78.
  • ,
  • Jordi Rello, (MD, PhD) (Research Assistant)

      Affiliations

    • Joan XXIII University Hospital, Pere Virgili Health Institute, University of Rovira and Virgili, CIBER, Enfermedades Respiratorias, Department of Intensive Care, Tarragona, Spain
    • Tel.: +34 977 29 58 18; fax: +34 977 29 58 78.
  • ,
  • Stijn I. Blot, (RN, CCRN, MNSc, PhD) (Professor)

      Affiliations

    • Ghent University Hospital and Faculty of Medicine and Health Sciences, Ghent University, Faculty of Healthcare, Ghent University College, Ghent, Belgium
    • Tel.: +32 9 332 62 16; fax: +32 9 332 49 95.

Received 18 April 2008 ,Revised 16 July 2008 ,Accepted 16 July 2008.

References 

  1. Almirall J, Gonzalez J, Rello J, Campistol JM, Montoliu J, Puig de la Bellacasa J, et al. Infection of hemodialysis catheters: incidence and mechanisms. Am. J. Nephrol. 1989;9:454–459
  2. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit. Care Med. 2001;29:1303–1310
  3. Atela I, Coll P, Rello J, Quintana E, Barrio J, March F, et al. Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research. J. Clin. Microbiol. 1997;35:1784–1790
  4. Bennett SN, Mcneil MM, Bland LA, Arduino MJ, Villarino ME, Perrotta DM, et al Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N. Engl. J. Med. 1995;333:147–154
  5. Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit. Care Med. 2004;32:2014–2020
  6. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, de Waele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin. Infect. Dis. 2005;41:1591–1598
  7. Blot SI, Labeau S, Vandijck D, van Aken P, Claes B. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intens. Care Med. 2007;33:1463–1467
  8. Boelaert JR, van Landuyt HW, Godard CA, Daneels RF, Schurgers ML, Matthys EG, et al. Nasal mupirocin ointment decreases the incidence of Staphylococcus aureus bacteraemias in haemodialysis patients. Nephrol. Dial. Transplant. 1993;8:235–239
  9. Bouza E, Munoz P, Lopez-Rodriguez J, Jesus Perez M, Rincon C, Martin Rabadan P, et al. A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study. J. Hosp. Infect. 2003;54:279–287
  10. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings. Recommendations of the healthcare infection control practices advisory committee and the HIPAC/SHEA/APIC/IDSA hand hygiene task force. Am. J. Infect. Control. 2002;30:S1–S46
  11. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. Jama. 1999;282:1458–1465
  12. CDC . National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am. J. Infect. Control. 2004;32:470–485
  13. Collignon PJ. Intravascular catheter associated sepsis: a common problem. The Australian Study on Intravascular Catheter Associated Sepsis. Med. J. Aust. 1994;161:374–378
  14. Collignon P, Soni N, Pearson I, Sorrell T, Woods P. Sepsis associated with central vein catheters in critically ill patients. Intens. Care Med. 1988;14:227–231
  15. Conly JM, Grieves K, Peters B. A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. J. Infect. Dis. 1989;159:310–319
  16. Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?. Jama. 1999;282:867–874
  17. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intens. Care Med. 2004;30:536–555
  18. Dimick JB, Pelz RK, Consunji R, Swoboda SM, Hendrix CW, Lipsett PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch. Surg. 2001;136:229–234
  19. Dinc L, Erdil F. The effectiveness of an educational intervention in changing nursing practice and preventing catheter-related infection for patients receiving total parenteral nutrition. Int. J. Nurs. Stud. 2000;37:371–379
  20. Eggimann P, Pittet D. Infection control in the ICU. Chest. 2001;120:2059–2093
  21. Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000;355:1864–1868
  22. Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect. Control Hosp. Epidemiol. 1996;17:150–158
  23. Harbarth S, Pittet D, Grady L, Goldmann DA. Compliance with hand hygiene practice in pediatric intensive care. Pediatr. Crit. Care Med. 2001;2:311–314
  24. Higuera F, Rosenthal VD, Duarte P, Ruiz J, Franco G, Safdar N. The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit. Care Med. 2005;33:2022–2027
  25. Hoste EA, Vandijck DM, van Holder RC, de Waele JJ, Lameire NH, Claus S, et al. Health implications of antimicrobial-resistance in bloodstream infection patients with acute kidney injury. Infect. Control Hosp. Epidemiol. 2007;28:1107–1110
  26. Hu KK, Lipsky BA, Veenstra DL, Saint S. Using maximal sterile barriers to prevent central venous catheter-related infection: a systematic evidence-based review. Am. J. Infect. Control. 2004;32:142–146
  27. Hu KK, Veenstra DL, Lipsky BA, Saint S. Use of maximal sterile barriers during central venous catheter insertion: clinical and economic outcomes. Clin. Infect. Dis. 2004;39:1441–1445
  28. Kac G, Podglajen I, Gueneret M, Vaupre S, Bissery A, Meyer G. Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study. J. Hosp. Infect. 2005;60:32–39
  29. Labeau SO, Vandijck DM, Claes B, van Aken P, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: development and validation of an evaluation questionnaire. Am. J. Crit. Care. 2007;16:372–377
  30. Leon C, Ruiz-Santana S, Rello J, de la Torre MV, Valles J, Alvarez-Lerma F, et al. Benefits of minocycline and rifampin-impregnated central venous catheters. A prospective, randomized, double-blind, controlled, multicenter trial. Intens. Care Med. 2004;30:1891–1899
  31. Lobo RD, Levin AS, Gomes LM, Cursino R, Park M, Figueiredo VB, et al. Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. Am. J. Infect. Control. 2005;33:83–87
  32. Lorenzen AN, Itkin DJ. Surveillance of infection in home care. Am. J. Infect. Control. 1992;20:326–329
  33. Maki DG, McCormack KN. Defatting catheter insertion sites in total parenteral nutrition is of no value as an infection control measure. Controlled clinical trial. Am. J. Med. 1987;83:833–840
  34. Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339–343
  35. Maki DG, Stolz SS, Wheeler S, Mermel LA. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit. Care Med. 1994;22:1729–1737
  36. Mayor S. Poor team work is killing patients. BMJ. 2002;325:1129
  37. Mermel LA. Prevention of intravascular catheter-related infections. Ann. Intern. Med. 2000;132:391–402
  38. 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;91:197S–205S
  39. Mermel LA, Farr BM, Sherertz RJ, Raad II, O’Grady N, Harris JS, et al. Guidelines for the management of intravascular catheter-related infections. Clin. Infect. Dis. 2001;32:1249–1272
  40. Mershon J, Nogami W, Williams JM, Yoder C, Eitzen HE, Lemons JA. Bacterial/fungal growth in a combined parenteral nutrition solution. JPEN, J. Parenter. Enteral. Nutr. 1986;10:498–502
  41. Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit. Care Med. 1996;24:1818–1823
  42. Nasraway SA. Eliminating catheter-related bloodstream infections: fairy tale or new reality?. Crit. Care Med. 2004;32:2150–2152
  43. Oeyen S, Vandijck D, Benoit D, Decruyenaere J, Annemans L, Hoste E. Long-term outcome after acute kidney injury in critically-ill patients. Acta Clin. Belg. 2007;(Suppl.):337–340
  44. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect. Control Hosp. Epidemiol. 2002;23:759–769
  45. Parenti CM, Lederle FA, Impola CL, Peterson LR. Reduction of unnecessary intravenous catheter use. Internal medicine house staff participate in a successful quality improvement project. Arch. Intern. Med. 1994;154:1829–1832
  46. Pearson ML. Guideline for prevention of intravascular device-related infections. Hospital Infection control practices advisory committee. Infect. Control Hosp. Epidemiol. 1996;17:438–473
  47. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. Jama. 1994;271:1598–1601
  48. Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch. Intern. Med. 1999;159:821–826
  49. Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect. Dis. 2006;6:641–652
  50. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N. Engl. J. Med. 2006;355:2725–2732
  51. Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect. Control Hosp. Epidemiol. 1994;15:231–238
  52. Rasero L, Degl’innocenti M, Mocali M, Alberani F, Boschi S, Giraudi A, et al. Comparison of two different protocols on change of medication in central venous catheterization in patients with bone marrow transplantation: results of a randomized multicenter study. Assist Inferm. Ric. 2000;19:112–119
  53. Rello J, Ochagavia A, Sabanes E, Roque M, Mariscal D, Reynaga E, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am. J. Respir. Crit. Care Med. 2000;162:1027–1030
  54. Riu S, Ruiz CG, Martinez-Vea A, Peralta C, Oliver JA. Spontaneous rupture of polyurethane peritoneal catheter. A possible deleterious effect of mupirocin ointment. Nephrol. Dial. Transplant. 1998;13:1870–1871
  55. Robert J, Fridkin SK, Blumberg HM, Anderson B, White N, Ray SM, et al. The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect. Control Hosp. Epidemiol. 2000;21:12–17
  56. Robinson JF, Robinson WA, Cohn A, Garg K, Armstrong JD. Perforation of the great vessels during central venous line placement. Arch. Intern. Med. 1995;155:1225–1228
  57. Rosenthal VD, Guzman S, Pezzotto SM, Crnich CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am. J. Infect. Control. 2003;31:405–409
  58. Salzman MB, Isenberg HD, Rubin LG. Use of disinfectants to reduce microbial contamination of hubs of vascular catheters. J. Clin. Microbiol. 1993;31:475–479
  59. Segura M, Alvarez-Lerma F, Tellado JM, Jimenez-Ferreres J, Oms L, Rello J, et al. A clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann. Surg. 1996;223:363–369
  60. Sesso R, Barbosa D, Leme IL, Sader H, Canziani ME, Manfredi S, et al. Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment. J. Am. Soc. Nephrol. 1998;9:1085–1092
  61. Sherertz RJ, Ely EW, Westbrook DM, Gledhill KS, Streed SA, Kiger B, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann. Intern. Med. 2000;132:641–648
  62. Smith RL. Prevention of infection in the intensive care unit. Curr. Opin. Infect. Dis. 2006;19:323–326
  63. Soifer NE, Borzak S, Edlin BR, Weinstein RA. Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial. Arch. Intern. Med. 1998;158:473–477
  64. Tsuchida T, Makimoto K, Toki M, Sakai K, Onaka E, Otani Y. The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison. Int. J. Nurs. Stud. 2006;
  65. Vandijck DM, Decruyenaere JM, Blot SI. The value of sepsis definitions in daily ICU-practice. Acta Clin. Belg. 2006;61:220–226
  66. Vandijck DM, Decruyenaere JM, Labeau SO, Depaemelaere M, Blot SI. Economic impact of catheter-related sepsis in the intensive care unit. ICU Manage. 2007;7:10
  67. Vandijck DM, Oeyen S, Decruyenaere JM, Annemans L, Hostel EA. Acute kidney injury, length of stay, and costs in patients hospitalized in the intensive care unit. Acta Clin. Belg. 2007;(Suppl.):341–345
  68. Vandijck DM, Reynvoet E, Blot SI, Vandecasteele E, Hoste EA. Severe infection, sepsis and acute kidney injury. Acta Clin. Belg. 2007;(Suppl.):332–336
  69. Vandijck DM, Blot SI, Labeau SO, Buyle FM, Depaemelaere M, Vandewoude KH, et al. Candidemia in critically ill patients: an analysis of daily antifungal therapy related costs. J. Mycol. Med. 2008;18:96–99
  70. Vandijck DM, Depaemelaere M, Labeau SO, Depuydt PO, Annemans L, Buyle FM, et al. Daily cost of antimicrobial therapy in patients with Intensive Care Unit-acquired, laboratory-confirmed bloodstream infection. Int. J. Antimicrob. Agents. 2008;31:161–165
  71. Vanholder R, van Biesen W. Incidence of infectious morbidity and mortality in dialysis patients. Blood Purif. 2002;20:477–480
  72. Vicca AF. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J. Hosp. Infect. 1999;43:109–113
  73. Warren D, Zack J, Mayfield J, Chen A, Prentice D, Fraser V, et al. The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest. 2004;126:1612–1618
  74. Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit. Care Med. 2006;34:2084–2089
  75. White MC, Ragland KE. Surveillance of intravenous catheter-related infections among home care clients. Am. J. Infect. Control. 1994;22:231–235
  76. Young EM, Commiskey ML, Wilson SJ. Translating evidence into practice to prevent central venous catheter-associated bloodstream infections: a systems-based intervention. Am. J. Infect. Control. 2006;34:503–506
  77. Zakrzewska-Bode A, Muytjens HL, Liem KD, Hoogkamp-Korstanje JA. Mupirocin resistance in coagulase-negative staphylococci, after topical prophylaxis for the reduction of colonization of central venous catheters. J. Hosp. Infect. 1995;31:189–193

PII: S1755-599X(08)00088-8

doi: 10.1016/j.ienj.2008.07.005

International Emergency Nursing
Volume 17, Issue 1 , Pages 60-68 , January 2009