or free water for enterally fed patients?

Posted on June 1, 2015 by John

CINAHL search with the following terms:

(enteral feeding OR tube feeding OR enteral nutrition OR feeding tube) AND (sterile OR saline OR water) AND (irrigation OR flush OR flushing)

Allen S. As a Flushing Agent for Enteral Nutrition, Does Sterile Water Compared to Tap Water Affect the Associated Risk of Infection in Critically Ill Patients?. Alabama Nurse [serial online]. March 2015;42(1):5-6. Available from: CINAHL, Ipswich, MA. Accessed June 1, 2015.

“ASPEN Enteral Nutrition Practice Recommendations.” JPEN, Journal of Parenteral and Enteral Nutrition 33.2 (2009):122.

“Enteral tube flushing.” American journal of nursing 105.3 (2005):58.

Peer-reviewed or evidenced-based practice articles regarding education for the reductions of central line associated bloodstream infections (CLABSI)

Posted on December 2, 2014 by Lisa

PubMed search: “Catheter-Related Infections/prevention and control”[MAJR] AND education AND (nurse OR nursing)

To examine all 40 results, please use this link: http://tinyurl.com/nd94rxq

choltz, Amy K, et al. “Central venous catheter dress rehearsals: translating simulation training to patient care and outcomes.” Simulation in Healthcare 8.5 (2013):341-9.

Frampton, Geoff K, et al. “Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation.” Health technology assessment 18.15 (2014):1-365.

Reed, Seth M, Alexandra JBrock, and Tyler JAnderson. “CE: Champions for central line care.” American journal of nursing 114.9 (2014):40-8; test 49.

Raup, Glenn H, JoycePutnam, and KathyCantu. “Can an education program reduce CLABSIs?” Nursing Management 44.5 (2013):20-2.

Fakih, Mohamad G, et al. “Peripheral venous catheter care in the emergency department: education and feedback lead to marked improvements.” American journal of infection control 41.6 (2013):531-6.

Peredo, R, et al. “Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention.” European journal of clinical microbiology & infectious diseases 29.9 (2010):1173-7.

Semelsberger, Carrie F. “Educational interventions to reduce the rate of central catheter-related bloodstream infections in the NICU: a review of the research literature.” Neonatal network 28.6 (2009):391-5.

Vandijck, Dominique M, et al. “The role of nurses working in emergency and critical care environments in the prevention of intravascular catheter-related bloodstream infections.” International emergency nursing 17.1 (2009):60-8.

Gerolemou, Louis, et al. “Simulation-based training for nurses in sterile techniques during central vein catheterization.” American journal of critical care 23.1 (2014):40-8.

What is the evidence linking disposable ECG cables and lead wire systems to decreased hospital acquired infections (HAIs)? What would the cost savings be?

Posted on September 15, 2014 by Amy

Studies focus on identifying presence of bacteria on devices, as opposed to devices being associated as the cause of HAI cases. Likewise, no published literature was identified that specifically demonstrated that use of disposable leads reduces the rate of HAIs.

Evidence Summary sources:

Joanna Briggs
Xue, Yifan. Noninvasive Portable Clinical Items: Healthcare Associated Infections. [Evidence Summaries]. JBI11266, 2014.
Cites studies demonstrating the prevalence of low-risk, potentially pathogenic, and multidrug resistant bacteria on non-invasive devices, including ECG lead wires.

Literature databases:

PubMed: cross infection AND (electrocardiography OR noninvasive devices) AND (disposable OR reusable OR reuse OR “single use”)

Microbial colonization of electrocardiographic telemetry systems before and after cleaning.
Reshamwala A, McBroom K, Choi YI, LaTour L, Ramos-Embler A, Steele R, Lomugdang V, Newman M, Reid C, Zhao Y, Granger BB.
Am J Crit Care. 2013 Sep;22(5):382-9. doi: 10.4037/ajcc2013365.
PMID: 23996417
contamination after cleaning reusable leads

Disposable vs reusable electrocardiography leads in development of and cross-contamination by resistant bacteria.
Brown DQ.
Crit Care Nurse. 2011 Jun;31(3):62-8. doi: 10.4037/ccn2011874.
PMID: 21632593
Review article

Cleaned, ready-to-use, reusable electrocardiographic lead wires as a source of pathogenic microorganisms.
Albert NM, Hancock K, Murray T, Karafa M, Runner JC, Fowler SB, Nadeau CA, Rice KL, Krajewski S.
Am J Crit Care. 2010 Nov;19(6):e73-80. doi: 10.4037/ajcc2010304.
PMID: 21041188
presence of pathogens on reusable leads

Potential micro-organism transmission from the re-use of 3M Red Dot adhesive electrocardiograph electrodes.
Daley AJ, Hennessy D, Cullinan J, Thorpe S, Alexander R.
J Hosp Infect. 2005 Nov;61(3):264-5. Epub 2005 Jul 5. No abstract available.
PMID: 16002182

CINAHL

A similar search of CINAHL did not identify any unique, relevant articles.

Cost savings

The cost savings of decreasing HAIs can be calculated by multiplying the estimated cost of an HAI by the number of HAIs in a given period of time. Then, subtract the cost of disposable equipment for all procedures occurring during that time period (i.e., the number of disposable cables that would be used with patients).

The CDC provides data on estimated cost of HAIs. Start at http://www.cdc.gov/hai/surveillance/. The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009, includes estimates for specific types of infections beginning on p. 5.

What is the recent evidence on whether closed catheter systems prevent catheter-associated bloodstream infections (CLABSIs)?

Posted on April 23, 2014 by Lisa

Ishizuka, Mitsuru, et al. “Needleless closed system does not reduce central venous catheter-related bloodstream infection: a retrospective study.” International surgery 98.1 (2013):88-93.

Newman, Nitza, et al. “Central venous catheter-associated bloodstream infections.” Pediatric blood & cancer 59.2 (2012):410-414.

Ellger, B, et al. “Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions.” Journal of hospital infection 78.1 (2011):31-35.

Graves, Nicholas, Adrian GBarnett, and Victor DRosenthal. “Open versus closed IV infusion systems: a state based model to predict risk of catheter associated blood stream infections.” BMJ open 1.2 (2011):e000188-e000188.

Maki, Dennis G, et al. “Impact of switching from an open to a closed infusion system on rates of central line-associated bloodstream infection: a meta-analysis of time-sequence cohort studies in 4 countries.” Infection control and hospital epidemiology 32.1 (2011):50-58.

McAfee, Nancy, et al. “A continuous quality improvement project to decrease hemodialysis catheter infections in pediatric patients: use of a closed luer-lock access cap.” Nephrology Nursing Journal 37.5 (2010):541-4.

Jarvis, William R, et al. “Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors.” Clinical infectious diseases 49.12 (2009):1821-1827.

Ishizuka, Mitsuru, et al. “Valve system does not reduce the catheter-related bloodstream infection.” Journal of investigative surgery 22.6 (2009):430-434.

Vilins, Margarete, et al. “Rate and time to develop first central line-associated bloodstream infections when comparing open and closed infusion containers in a Brazilian Hospital.” The Brazilian journal of infectious diseases 13.5 (2009):335-340.

Ivy, D D, et al. “Closed-hub systems with protected connections and the reduction of risk of catheter-related bloodstream infection in pediatric patients receiving intravenous prostanoid therapy for pulmonary hypertension.” Infection control and hospital epidemiology 30.9 (2009):823-829.

Franzetti, F, et al. “Impact on rates and time to first central vascular-associated bloodstream infection when switching from open to closed intravenous infusion containers in a hospital setting.” Epidemiology and Infection 137.7 (2009):1041-1048.

Blake, Molly. “Update: Catheter-related bloodstream infection rates in relation to clinical practice and needleless device type.” The Canadian journal of infection control 23.3 (2008):156-60, 162.

How should closed catheter systems be maintained?

Posted on April 23, 2014 by Lisa

Rupp, Mark E, et al. “Adequate disinfection of a split-septum needleless intravascular connector with a 5-second alcohol scrub.” Infection control and hospital epidemiology 33.7 (2012):661-665.
This is a prospective observational clinical survey and laboratory assessment of disinfection procedures.

Aly, Hany, et al. “Is bloodstream infection preventable among premature infants? A tale of two cities.” Pediatrics 115.6 (2005):1513-1518.
Described the protocol for maintaining a closed medication system.

Does changing needleless caps reduce the rate of infections?

Posted on April 22, 2014 by Lisa

Conflicting evidence exists on whether changing needleless caps reduces the rate of infections.

Do, A N, et al. “Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting.” The Journal of infectious diseases 179.2 (1999):442-448.
Cohort study found that rate of bloodstream infections (BSIs) rate “decreased as the frequency of changing the needleless device end cap increased from once weekly up to every 2 days, suggesting that the mechanism for BSI may involve contamination from the end cap.”

McDonald, L C, S N NBanerjee, and W R RJarvis. “Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy.” Infection control and hospital epidemiology 19.10 (1998):772-777.
Bloodstream infection (BSI) rates increased in patients receiving “intermittent (vs continuous) intravenous therapy through one or more lumens. The IVAC device valvecomponent was replaced every 6 days, and the endcap used to cover the valve (when connected to an unused lumen) was replaced every 24 hours or after each access. The BSI rate returned to baseline after institution of a policy to replace the entire IVAC device, valve, and endcap every 24 hours.”

Danzig, L E, et al. “Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.” JAMA: the Journal of the American Medical Association 273.23 (1995):1862-1864.
Researchers conducted case-control and retrospective cohort studies. Data found that needleless device used for total parenteral nutrition and intralipid therapy (TPN/IL) “was associated with increased risk of BSI when injection caps were changed every 7 days.”

What are the most recent guidelines for preventing catheter associated urinary tract infections (CAUTI)?

Posted on April 18, 2014 by Amy

The Catheter-associated urinary tract infection topic in DynaMed identifies these US guidelines:

IDSA guideline on diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults can be found in Clin Infect Dis 2010 Mar 1;50(5):625
Healthcare Infection Control Practices Advisory Committee (HICPAC, panel to CDC and HHS) guideline on prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010 Apr;31(4):319 or National Guideline Clearinghouse
Society for Healthcare Epidemiology of America guideline on strategies to prevent catheter-associated urinary tract infections in acute care hospitals can be found in Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S41 or at National Guideline Clearinghouse

Evidence Matters

Evidence-based information for Emory

Tag Archives: Infection Control