Keywords
catheter-related phlebitis
catheter-related bloodstream infections
epidemic situation
How to Cite
Abstract
The issue of prevention and treatment of healthcare-associated infections (HCI), and in particular intravascular catheter-related infections associated with (ICRI), still remains unresolved. The purpose of the work was to determine the shortcomings in the epidemiological surveillance (ES) for ICRI and the ways to correct them, with the further development of an effective system of ES for ICRI in multidisciplinary healthcare settings. In 2019‒2020, a comprehensive epidemiological study was conducted. It was conducted on the basis of the surgical and intensive care units in multidisciplinary healthcare settings. The study included a retrospective epidemiological analysis of 160 medical records of inpatients on the use of intravascular catheters, a cross-sectional epidemiological study of the use of intravascular catheters, prospective epidemiological observation of 94 patients with intravascular catheters (n=149), a cross-sectional epidemiological study of the level of knowledge, attitude and practice of using intravascular catheters and adherence to infection control rules of 123 healthcare workers (HCW). No cases of catheter-related phlebitis or other ICRI were documented in the medical records of inpatients. An analysis of the completeness of the documentation of the catheterization procedure revealed that in 100% of cases, the probable duration of catheterization, the results of daily observation of the catheterization site, information about the change of dressings and washing of the vascular catheter were not routinely recorded. HCW have an insufficient level of knowledge about epidemiological features, infection control and prevention of ICRI. The majority of HCW (80.0±3.65%) feel the need to receive additional information regarding possible complications of vascular catheterization, infection control, and prevention of ICRI. Taking into account the mentioned shortcomings, a system of ES for ICRI in the multidisciplinary healthcare setting was developed. It includes three structural modules: informational, diagnostic and management. The developed ES system according to the ICRI is suitable for use in multidisciplinary healthcare settings and can be adapted according to the material and technical capacity of the healthcare settings.
Keywords: infection control, catheter-related phlebitis, catheter-related bloodstream infections, epidemic situation.
References
Fernando S, Gray T, Gottlieb T. Healthcare-acquired infections: prevention strategies. Internal Medicine Journal. 2017;47(12):1341‒51. DOI: 10.1111/imj.13642. PMID: 29224205.
Mauger B, Marbella A, Pines E, Chopra R, Black E, Aronson N. Implementing quali-ty improvement strategies to reduce healthcare-associated infections: A systematic review. Ame¬rican Journal of Infection Control. 2014;42(10):S274‒83. DOI: 10.1016/j.ajic.2014.05.031. PMID: 25239722.
Moore Z, Billings C, DeRienzo C. Preventing health care-associated infections: con-necting North Carolina's patients to national efforts. North Carolina Medical Journal. 2016;77(5):334‒6. DOI: 10.18043/ncm.77.5.334. PMID: 27621344.
Burke J. Infection control – a problem for patient safety. New England Journal of Medicine. 2003;348(7):651‒6. DOI: 10.1056/nejmhpr020557. PMID: 12584377.
Revelas A. Healthcare-associated infections: A public health problem. Nigerian Me-dical Journal. 2012;53(2):59. DOI: 10.4103/0300-1652.103543. PMID: 23271847.
Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections – an overview. Infection and Drug Resistance. 2018;11:2321-33. DOI: 10.2147/idr.s177247. PMID: 30532565.
Stevens V, Geiger K, Concannon C, Nelson R, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infec-tions. Clinical Microbiology and Infection. 2014;20(5):O318‒24. DOI: 10.1111/1469-0691.12407. PMID: 24112305.
Brown R, Burke D. The hidden cost of catheter related blood stream infections in pa-tients on parenteral nutrition. Clinical Nutrition ESPEN. 2020;36:146-9. DOI: 10.1016/ j.clnesp.2020.01.001. PMID: 32220358.
Dal Forno C, Correa L, Scatena P, Silva C, Shiramizo S, Pavão dos Santos O, et al. Bloodstream infection in the intensive care unit: Preventable adverse events and cost savings. Value in Health Regional Issues. 2012;1(2):136‒41. DOI: 10.1016/j.vhri.2012.10.002. PMID: 29702892.
Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central ve-nous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health and Quality of Life Outcomes. 2018;16(1). DOI: 10.1186/s12955-018-1027-3. PMID: 30305105.
Hollenbeak C. The Cost of Catheter-Related Bloodstream Infections. Journal of In-fusion Nursing. 2011;34(5):309‒13. DOI: 10.1097/nan.0b013e3182285e43. PMID: 21915004.
Sagana R, Hyzy R. achieving zero central line-associated bloodstream infection rates in your intensive care unit. Critical Care Clinics. 2013;29(1):1‒9. DOI: 10.1016/ j.ccc.2012.10.003. PMID: 23182523.
Smith R, Meixler S, Simberkoff M. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest. 1991;100(1):164‒7. DOI: 10.1378/chest.100.1.164. PMID: 2060337.
Rosenthal V. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: A prospec-tive, matched analysis. American Journal of Infection Control. 2003;31(8):475‒80. DOI: 10.1016/j.ajic.2003.03.002. PMID: 14647110.
Tacconelli E, Smith G, Hieke K, Lafuma A, Bastide P. Epidemiology, medical out-comes and costs of catheter-related bloodstream infections in intensive care units of four Eu-ropean countries: literature- and registry-based estimates. Journal of Hospital Infection. 2009;72(2):97‒103. DOI: 10.1016/j.jhin.2008.12.012. PMID: 19246122.
Results | Agency for Healthcare Research and Quality [Internet]. Ahrq.gov. 2017 [cited 26 Aug 2020]. Available from: https://www.ahrq.gov/hai/pfp/haccost2017-results.html
Higuera F, Rangel-Frausto M, Rosenthal V, Soto J, Castañon J, Franco G, et al. At-tributable cost and length of stay for patients with central venous catheter-associated blood-stream infection in Mexico city intensive care units A prospective, matched analysis. Infection Control & Hospital Epidemiology. 2007;28(1):31‒5. DOI: 10.1086/510812. PMID: 17315338.
Kayambankadzanja R, Lihaka M, Barratt-Due A, Kachingwe M, Kumwenda W, Lester R et al. The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi. BMC Infectious Diseases. 2020;20(1). DOI: 10.1186/s12879-020-05505-6. PMID: 33076857.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety. 2014;5(6):229‒41. DOI: 10.1177/2042098614554919. PMID: 25436105.
Kayambankadzanja R, Lihaka M, Barratt-Due A, Kachingwe M, Kumwenda W, Lester R et al. The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi. BMC Infectious Diseases. 2020;20(1). DOI: 10.1186/s12879-020-05505-6. PMID: 33076857.
Berezhna AV, Chumachenko TO. Svidotstvo pro reiestratsiiu avtorskoho prava na tvir [Certificate of copyright registration for the work] No. 91939 "Naukovyi tvir "Forma ekspertnoi otsinky medychnoi karty statsionarnoho khvoroho shchodo naiavnosti faktoriv ryzyku infektsii krovotoku" ["Scientific work "Form of expert evaluation of the medical card of an inpatient regarding the presence of risk factors for bloodstream infections"]. Data reiestratsii [Registration date]: 28 Aug 2019. [In Ukrainian].
Berezhna AV, Chumachenko TO. Svidotstvo pro reiestratsiiu avtorskoho prava na tvir [Certificate of copyright registration for the work] No. 91940 "Naukovyi tvir "Karta epidemiolohichnoho sposterezhennia za statsionarnym khvorym dlia vstanovlennia faktoriv ryzyku infektsii, poviazanykh z vykorystanniam vnutrishnosudynnykh kateteriv" ["Scientific work "Card of epidemiological observation of an inpatient for the establishment of risk factors for intravascular catheter-related infections"]. Data reiestratsii [Registration date]: 28 Aug 2019. [In Ukrainian].
Chumachenko TO, Berezhna AV. Svidotstvo pro reiestratsiiu avtorskoho prava na tvir [Certificate of copyright registration for the work] No. 84621 "Naukovyi tvir "Opytuvalnyk "Vykorystannia vnutrishnosudynnykh kateteriv u klinichnii praktytsi" ["Scientific work "Questionnaire "Use of intravascular catheters in clinical practice"]. Data reiestratsii [Registration date]: 21 Jan 2019. [In Ukrainian].
Glantz S. Mediko-biologicheskaya statistika [Primer of biostatistics]. Moskva [Moscow], Praktika [Practice]; 1998. 459 p. [In Russian].
Selimen D, Kihc G, Toker K. Incidence of phlebitis related to peripheral vein catheterization: comparison of teflon and vialon. Hemsirelik Bulteni. 1995;9(38):49–56.
O'Grady N, Alexander M, Burns L, Dellinger E, Garland J, Heard S et al. Guidelines for the prevention of intravascular catheter-related Infections. Clinical Infectious Diseases. 2011;52(9):e162‒93. DOI: 10.1093/cid/cir257. PMID: 21460264.
Berezhna AV, Chumachenko TO. Informatsiinyi lyst pro novovvedennia v sferi okhorony zdorovia [Information letter about innovations in the field of health care] No. 13-2021 "Sposib rannoho vyiavlennia uskladnen pry kateteryzatsii peryferychnykh ven na osnovi vykorystannia shkaly vizualnoi otsinky rozvytku infuziinoho flebitu" ["The method of early detection of complications during catheterization of peripheral veins based on the use of a visual assessment scale for the development of infusion phlebitis"]. Kharkiv: KhNMU; Kyiv: Ukrmedpatentinform Ministry of Health of Ukraine; 2021. 4 p. [In Ukrainian].
Berezhna AV, Chumachenko TO. Informatsiinyi lyst pro novovvedennia v sferi okhorony zdorovia [Information letter about innovations in the field of health care] No. 14-2021 "Sposib vyznachennia faktoriv ryzyku uskladnen, poviazanykh iz zastosuvanniam sudynnykh kateteriv, na osnovi vykorystannia chek-lystu “Kateteryzatsiia sudyn" ["The method of determining the risk factors of complications associated with the use of vascular catheters, based on the use of the "Vascular Catheterization" checklist"]. Kharkiv: KhNMU; Kyiv: Ukrmedpatentinform Ministry of Health of Ukraine; 2021. 4 p. [In Ukrainian].
Berezhna AV, Chumachenko TO. Informatsiinyi lyst pro novovvedennia v sferi okhorony zdorovia [Information letter about innovations in the field of health care] No. 12-2021 "Sposib optymizatsii vykorystannia sudynnykh kateteriv u statsionarnykh khvorykh na osnovi vykorystannia lysta shchodennoho sposterezhennia za mistsem kateteryzatsii u patsiienta z sudynnym kateterom" ["The method of optimizing the use of vascular catheters in inpatients based on the use of a sheet of daily observation of the catheterization site in a patient with a vascular catheter"]. Kharkiv: KhNMU; Kyiv: Ukrmedpatentinform Ministry of Health of Ukraine; 2021. 4 p. [In Ukrainian].