CRBSIs & Dressing Disruption: QI Initiatives Demonstrate Improved Adherence

Welcome back to the third in this series of blogs focusing on Catheter-Related Bloodstream Infections (CRBSIs). In the first blog, the importance of ensuring the integrity of medical dressings and devices over extended periods of time was reviewed (View Blog 1 of 3). Blog 2 of the series reviewed the clinical impact products compatible with chlorhexidine gluconate (CHG) have on CRBSIs (View Blog 2 of 3).

This blog will examine quality improvement (QI) initiatives undertaken at 3 separate institutions that led to noteworthy findings, all of which were presented at various scientific meetings in poster format.1-3

QI INITIATIVE 1: Increase Catheter Dressing Adherence1
DESCRIPTION: A before-after survey was conducted by licensed nursing personnel to assess catheter adherence. Dressing observations made included dry/intact; edges lifted; partially lifted; and total detachment.
PURPOSE: Observe the impact of Mastisol® Liquid Adhesive use on central venous catheter (CVC) dressing adherence in a Florida hospital.

Poster presented at the Association for Vascular Access Annual Scientific Meeting, Sept. 2014

KEY FINDING: Use of Mastisol® resulted in:

  • 92% decrease in impaired internal jugular (IJ) dressings
  • 67% decrease in impaired Peripherally Inserted Central Catheter (PICC) dressings

 

QI INITIATIVE 2: Enhance Adherence to Best Practices2
DESCRIPTION: An evidence-based, nurse-driven initiative was designed and implemented to reduce central line dressing disruptions.
PURPOSE: Determine the effectiveness of Mastisol® for enhancing CVC dressing adherence. Central-line associated bloodstream infections (CLABSI) were also monitored before, during and after the QI initiative (this is referred to as a point prevalence survey).

Poster presented at the Greater Cincinnati AACN Chapter Meeting, April 2016

KEY FINDINGS:

  • At three separate survey points after the CVC procedure was modified to include Mastisol®, 0% of dressings were non-adherent
  • When use of Mastisol® was implemented, dressing change frequency reduced from 2 times per week to 1 time per week
  • CLABSI rates were reduced by 76% by the third survey following the intervention (from 2.9 to 0.7 per 1000 device days)
  • Reducing dressing disruption should be part of comprehensive care bundle in order to prevent CLABSI in high-risk patients

 

QI INITIATIVE 3: Improve Adhesion of Internal Jugular Dressings3
DESCRIPTION: A root cause analysis found an increased number of central venous catheter (CVC) insertions in the internal jugular (IJ) site which were associated with dressing disruption, and about 70% of catheter dressings were changed before day 7. Before-after point prevalence surveys were conducted.
PURPOSE:Determine the effect of Mastisol® on the adherence of all IJ CVC dressings in 2 ICUs within a hospital (a root cause analysis had shown an increased number of CVC insertions at the IJ site were associated with dressing disruption, and 70% of CVC dressings were being changed before day 7).

Poster presented at the Association for Vascular Access Annual Scientific Meeting, Sept. 2016

KEY FINDINGS:

  • 76% more dressings were dry and intact after the intervention compared with before the intervention
  • Before the intervention, 61% of dressings were changed on day 1 due to compromised status, compared to 13% after the intervention

These QI initiatives further demonstrate the use of Mastisol® to reduce likelihood of dressing disruption, and minimize the risk of infection by creating a lasting occlusive dressing barrier.

For more information about Mastisol®, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1-877-433-7626 or visit www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce risk of conditions like a CAUTI, CLABSI, or SSI.

Next time, join us for a 2-part series on the prevalence and treatment of Medical Adhesive-Related Skin Injuries (MARSI).

Reference:

  1. Pullen D. Quality Improvement Initiative to Improve Dressing Adherence Reveals Improved Dressing Adherence Observations on a Before-After Analysis. Presented at: Association for Vascular Access Annual Scientific Meeting, September 7-10, 2014; Washington DC.
  2. Browne B, Moffo H. Quality Improvement Initiative Results in Fewer Dressing Disruptions and Improved Adherence to Best Practices. Presented at: Greater Cincinnati AACN Chapter, 28th Annual Trends in Critical Care Conference, April 8, 2016.
  3. Niehaus S, McCord J. Improving Adhesion of Internal Jugular Dressings in the Intensive Care Unit. Presented at Association for Vascular Access Annual Scientific Meeting, September 16-19, 2016. Orlando, FL.

CHG compatibility and CRBSI Reduction: Does it Matter?

The last blog began a 3-part series focusing on catheter-related bloodstream infections (CRBSIs). We saw that as vascular catheter use has increased, bloodstream infections have become a costly complication of health care. We also reviewed how preventing dressing disruption with Mastisol Liquid Adhesive® reduces the likelihood of dressing displacement and minimizes the risk of infection. (View Blog 1 of 3) In this second part of the series, we will examine the impact of products compatible with chlorhexidine gluconate (CHG) have on CRBSIs.

With estimates of over 250,000 CRBSIs occurring annually in the US1, it is clearly an issue that healthcare practices and facilities must address. One of the effective strategies used to combat microbial access to catheter insertion sites—and also recommended by the CDC in their Infusion Therapy Guidelines2 —is what is often considered the “gold standard” of antimicrobials, chlorhexidine gluconate, also known as CHG.

Reasons alcohol-based CHG is
the preferred antiseptic3

  • residual activity
  • fast dry time
  • broad spectrum activity
    • gram-positive bacteria
    • gram-negative bacteria
    • facultative anaerobes and aerobes
    • yeasts
    • some lipid-enveloped viruses

One of the unique features of CHG is its sustained activity against a broad spectrum of gram-negative and gram-positive bacteria, yeast and lipid-enveloped viruses.3

Knowing that dressing disruption increases the risk of CRBSIs, maintaining dressing integrity will help diminish the risk of infection and reduce unplanned dressing changes and associated costs.2

Frequently, improved dressing adherence is enhanced with the use of a gum mastic liquid adhesive, yet one might wonder, are all adhesives compatible with CHG?

To that end, the Journal of Infusion Nursing recently published a prospective, randomized, blocked-design trial that evaluated the compatibility of a gum mastic liquid adhesive (GMLA) and a liquid adhesive remover with an alcohol-based chlorhexidine gluconate skin prep. The 2 commercial test products evaluated for compatibility with a 2% CHG and 70% IPA antiseptic skin preparation were Mastisol® Liquid Adhesive, a non–water-soluble gum mastic liquid adhesive (GMLA) and Detachol® Adhesive Remover, a nonirritating liquid adhesive (LAR).3

The study demonstrated that: 3

  • Mastisol® and Detachol® were compatible with CHG applied to the skin
  • There were no statistically significant differences in bacterial populations following use of the CHG/IPA product alone versus use of the CHG/IPA product with either product at both 3 and 7 days after application

The documented compatibility of Mastisol® with CHG ensures that use of this liquid adhesive will not compromise the antiseptic protection of the insertion-site wound against transient organisms and contamination. Moreover, the use of Detachol® with CHG can ensure that appropriate technique is used for dressing removal, without impairing antiseptic coverage.3

The study concluded that GMLAs and LARs should be considered important additions to dressing management policies and maintenance care bundles. However, all GMLAs and LARs are not created equally—not all have proven CHG compatibility.3

For more information about Mastisol® and Detachol®, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1-877-433-7626 or visit www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce risk of conditions like a CAUTI, CLABSI, or SSI.

Join us next time for the last of this 3-part series, “CRBSIs & Dressing Disruption: QI Initiatives Demonstrate Improved Adherence.

References

  1. Shah H, Bosch W, Thompson KM, et al. Intravascular catheter-related bloodstream infection. Neurohospitalist. 2013;3(3):144-151.
  2. O’Grady NP, Alexander M, Burns LA, et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011; 39(4 Suppl 1): S1-34. doi: 10.1016/j.ajic.2011.01.033.
  3. Ryder M, Duley C. Evaluation of compatibility of a gum mastic liquid adhesive and liquid adhesive remover with an alcoholic chlorhexidine gluconate skin preparation. J Infus Nurs. 2016;40(4):245-252.

CRBSIs: Reduce Infection Risks by Maintaining Integrity of Vascular Access Device Dressings

This is the first of a 3-part series focusing on catheter-related bloodstream infections (CRBSIs). As catheter use increases, bloodstream infections (BSIs) resulting from intravascular catheters have become a costly complication of health care.

To start, the terms CRBSI and central line–associated bloodstream infection (CLABSI) are often used interchangeably to describe intravascular device (IVD)–related bloodstream infections. However, there are differences. According to the Association for Professionals in Infection Control and Epidemiology (APIC)1:

  • CRBSI is a rigorous clinical definition, defined by precise laboratory findings that identify the central venous catheter (CVC) as the source of the BSI and that are used to determine diagnosis, treatment, and possibly epidemiology of BSI in patients with a CVC
  • CLABSI is a term used only for surveillance purposes to identify BSIs that occur in the population at risk (patients with central lines)

The costs of treating BSIs resulting from intravascular catheters range from $670 million to $2.68 billion annually in the US2, and up to $29,156 per incidence of a CLABSI.3 Unfortunately, CRBSIs are a common complication in patients admitted to the Intensive Care Unit. In fact, since 2008, hospitals are no longer reimbursed by the US Centers for Medicare and Medicaid Services for hospital-acquired infections (HAIs) like CRBSI.4 As a result, healthcare providers are under great pressure to decrease the rates of HAIs.

CRBSI Quality Improvement is a key objective for most practices and facilities. Because dressing disruption has been determined to be a major factor in the development of CRBSIs,5 the importance of ensuring the integrity of medical dressings and devices over extended periods of time cannot be overstated.

A large cohort of patients was studied in a randomized multicenter trial to determine the importance of dressing disruption on the risk for development of CRBSI.5 The results showed:

  • 67% (7,347 of 11,036) of the dressing changes were performed before the planned date due to soiling or undressing
  • When the final dressing was disrupted, the risk of catheter colonization or infection increased 12-fold

These results may have you questioning the durability of dressings. This was precisely what initiated another study, which evaluated the durability and associated costs of different CVC dressings.6

During the 12-month trial period, a total of 1229 CVC dressings were observed from 590 CVCs. The results demonstrated that few CVC dressing remained adherent for 7 days. While 1 dressing appeared to last longer than the others, it was still below the recommended standard and at increased cost. The study also considered the associated time and costs of the dressing changes.

While 1 dressing had a median duration of 68.5 [32-105] hours, the other 3 dressings compared at 43.5, 46.0 and 40.5 hours (P<0.001). There was no significant difference in the median dressing duration between the other 3 dressings (p=0.74).

The results of these studies demonstrate the need to ensure the integrity of vascular access device dressings between scheduled changes. It is clear this can’t be accomplished by a dressing alone. The superior adhesiveness of Mastisol® Liquid Adhesive has been clinically demonstrated. Using Mastisol®:

  • Reduces the likelihood of dressing disruption 7, 8
  • Minimizes the risk of infection by creating a lasting occlusive dressing barrier 9,10

For more information about Mastisol® Liquid Adhesive, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1-877-433-7626 or visit www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of conditions like a CAUTI, CLABSI, or SSI.

Join us next time for the second of this 3-part series where we’ll explore the impact of CHG-compatible products on CRBSIs in our post entitled, “CHG Compatibility and CRBSI Reduction: Does it Matter?

References

  1. Accessed September 18, 2017.
  2. Shah H, Bosch W, Thompson KM, et al. Intravascular catheter-related bloodstream infection. Neurohospitalist. 2013;3(3):144-151.
  3. Scott RD II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Centers for Disease Control and Prevention. March 2009. Available at: http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf.
  4. Stone PW. Changes in Medicare reimbursement for hospital-acquired conditions including infections. Am J Infect Control. 2009;37:17A-18A
  5. Timsit JF, Bouadma L, Ruckly S, et al. Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med. 2012;40:1707-1714.
  6. Richardson A, Melling A, Straughan C, et al. Central venous catheter dressing durability: an evaluation. J Infect Prev. 2015;16(6):256–261.
  7. Pullen D. Quality Improvement Initiative to Improve Dressing Adherence Reveals Improved Dressing Adherence Observations on a Before-After Analysis. Presentation at AVA 2014 Annual Scientific Meeting, Washington DC, September 2014. Guide to the Elimination of Catheter-Related Bloodstream Infections. Association for Professionals in Infection Control and Epidemiology; Washington, DC: 2009. https://apic.org/.
  8. Niehaus S, McCord J. Improving Adhesion of Internal Jugular Dressings in the Intensive Care Unit. Presentation at Association for Vascular Access Annual Scientific Meeting in Orlando, FL, September 2016.
  9. Browne B, Moffo H. Quality Improvement Initiative Results in Fewer Dressing Disruptions and Improved Adherence to Best Practices. Presentation at Greater Cincinnati AACN Chapter, 28th Annual Trends in Critical Care Conference, Cincinnati, OH, April 2016.
  10. Boudreaux A. Ventriculostomy Dressing Process Improvement. Presentation at National Teaching Institute & Critical Care Exposition, Boston, MA, May 2013.