2.50
Hdl Handle:
http://hdl.handle.net/10755/203221
Type:
Presentation
Title:
Sustained Reduction of CABSI--Does Silver Make the Difference?
Abstract:
(Summer Institute) Problem: In 2008 the catheter associated bloodstream infection rate (CABSI) in this Burn Center was 6.3 per 1000 central line (CVC) days. The greatest interval between CABSI was 61 days. NHSN pooled mean CABSI rate for Burn Centers was 5.5/1000 CVC days. By early2009 our CABSI rate had escalated to 14.8/1000. The purpose of this evidence based practice (EBP) project was to evaluate the impact of silver coated dressings and IV connectors on CABSI rates in the Burn Center. Evidence: CABSI are the most common healthcare associated infection in the critical burn patient and the leading cause of morbidity and mortality (Cone, 2005; Shupp, 2010). Most CABSIs emanate from the insertion site, hub or both (Mermel, 2009). EBP strategies to reduce acquired infections have been widely published including silver-impregnated plastic catheters and biofilms (Hill, 2009; Khattak, 2009; Mermel, 2009). Strategy: Concurrent surveillance for device associated infections is performed within the Burn Center and data is submitted monthly to NHSN network. A PICO question was formulated: In burn patients with CVC or PICC how the use of silver-alginate-coated dressing and silver-coated IV connector impact the rate of CABSI? Practice Change: Maximum barrier precautions, chlorhexidine skin antiseptics, antimicrobial impregnated catheters and daily assessment of catheter need with documentation of line insertion days have been our standard practice. In May 2009, use a silver-alginate-coated dressing and a silver-coated IV connector was initiated with CVC and PICC lines. Evaluation: CABSI are reported quarterly as number per 1000 central line days. CABSI rates and interval between CABSI were tracked before and after this evidence-based practice change. Results: The CABSI rate declined to 5.4/1000 in late 2009. CVC days were reduced by 53% and arterial lines by 60%. The interval between CABSI increased to 141 days. In first quarter 2010, the CABSI rate declined to 2.8/1000 days with reduction of CVC days by 62% and arterial lines by 60%. In the 2010 first quarter the interval between CABSI is 114 days. Recommendations: These EBP changes have led to a reduction in CABSI and the number of line use days. The Burn Center team plans to replicate the review for urinary catheter infections. Lessons Learned: Skin assessment documentation even photography with silver dressing application should be discussed. We learned that diligent monitoring of our practice must not be lessened when the results show improvement. Bibliography: Cone JB. What’s new in general surgery: burns and metabolism. J Am Coll Surg. 2005;200(4):607-15. Hill ML, Baldwin JC, Slaughter JC, et al. A silver-alginate dressing to reduce peripherally inserted central catheter (PICC) infections in NICU patients: a pilot randomized controlled trial. J Perinatol. December;30:1-5, 2005. Khattak AZ, Ross R, Ngo T, Shoemaker CT. A randomized controlled evaluation of absorption of silver with the use of silver alginate (Algidex) patches in very low birth weight (VLBW) infants with central lines. J Perinatol. November 26; 30:1-6, 2009. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. July;49(1):1-45, 2009. Shupp JW, Pavlovich AR, Jeng JC, et al. Epidemiology of bloodstream infections in burn –injured patients: a review of the National Burn Repository. J Burn Care Res. 31(4);521-8, 2010. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
CABSI; Silver
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleSustained Reduction of CABSI--Does Silver Make the Difference?en_GB
dc.identifier.urihttp://hdl.handle.net/10755/203221-
dc.description.abstract(Summer Institute) Problem: In 2008 the catheter associated bloodstream infection rate (CABSI) in this Burn Center was 6.3 per 1000 central line (CVC) days. The greatest interval between CABSI was 61 days. NHSN pooled mean CABSI rate for Burn Centers was 5.5/1000 CVC days. By early2009 our CABSI rate had escalated to 14.8/1000. The purpose of this evidence based practice (EBP) project was to evaluate the impact of silver coated dressings and IV connectors on CABSI rates in the Burn Center. Evidence: CABSI are the most common healthcare associated infection in the critical burn patient and the leading cause of morbidity and mortality (Cone, 2005; Shupp, 2010). Most CABSIs emanate from the insertion site, hub or both (Mermel, 2009). EBP strategies to reduce acquired infections have been widely published including silver-impregnated plastic catheters and biofilms (Hill, 2009; Khattak, 2009; Mermel, 2009). Strategy: Concurrent surveillance for device associated infections is performed within the Burn Center and data is submitted monthly to NHSN network. A PICO question was formulated: In burn patients with CVC or PICC how the use of silver-alginate-coated dressing and silver-coated IV connector impact the rate of CABSI? Practice Change: Maximum barrier precautions, chlorhexidine skin antiseptics, antimicrobial impregnated catheters and daily assessment of catheter need with documentation of line insertion days have been our standard practice. In May 2009, use a silver-alginate-coated dressing and a silver-coated IV connector was initiated with CVC and PICC lines. Evaluation: CABSI are reported quarterly as number per 1000 central line days. CABSI rates and interval between CABSI were tracked before and after this evidence-based practice change. Results: The CABSI rate declined to 5.4/1000 in late 2009. CVC days were reduced by 53% and arterial lines by 60%. The interval between CABSI increased to 141 days. In first quarter 2010, the CABSI rate declined to 2.8/1000 days with reduction of CVC days by 62% and arterial lines by 60%. In the 2010 first quarter the interval between CABSI is 114 days. Recommendations: These EBP changes have led to a reduction in CABSI and the number of line use days. The Burn Center team plans to replicate the review for urinary catheter infections. Lessons Learned: Skin assessment documentation even photography with silver dressing application should be discussed. We learned that diligent monitoring of our practice must not be lessened when the results show improvement. Bibliography: Cone JB. What’s new in general surgery: burns and metabolism. J Am Coll Surg. 2005;200(4):607-15. Hill ML, Baldwin JC, Slaughter JC, et al. A silver-alginate dressing to reduce peripherally inserted central catheter (PICC) infections in NICU patients: a pilot randomized controlled trial. J Perinatol. December;30:1-5, 2005. Khattak AZ, Ross R, Ngo T, Shoemaker CT. A randomized controlled evaluation of absorption of silver with the use of silver alginate (Algidex) patches in very low birth weight (VLBW) infants with central lines. J Perinatol. November 26; 30:1-6, 2009. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. July;49(1):1-45, 2009. Shupp JW, Pavlovich AR, Jeng JC, et al. Epidemiology of bloodstream infections in burn –injured patients: a review of the National Burn Repository. J Burn Care Res. 31(4);521-8, 2010. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectCABSIen_GB
dc.subjectSilveren_GB
dc.date.available2012-01-16T11:04:11Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:04:11Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.