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broviac catheters and implantable ports
Volume 20 Number 2
A CLINICAL INDICATOR FOR PEDIATRIC ONCOLOGY PATIENTS: PROSPECTIVE MONITORING FOR INFECTIONS ASSOCIATED WITH HICKMAN/BROVIAC CATHETERS AND IMPLANTABLE PORTS. J. Umphrey, MT (ASCP), MPH,* J. Tan'and, MD, I. Raad, MD. University of Texas M.D. Anderson Cancer Center, Houston, TX. With more intensive chemotherapy comes the significant need for ease of administration of chemotherapy and blood products to the pediatric oncology patient. Central venous catheters ease the task and are also crucial to supportive care. In 1989 concern was expressed that there were unusually high numbers of patients with central venous catheter-associated sepsis. The high risk nature of these patients, along with our lack of baseline infection rates, led to the development of this monitoring activity. From July 1989 through October 1991, all patients having surgical placement of a Hickmnn or Broviac (HB) catheter, or an implantable port (P) under general anesthesia were prospectively monitored for catheter-associated infections until the time of catheter removal or November 30, 1991. Standardized data collection forms were collected for all patients which included documentation of infectious complications. Surveillance yielded the following results: 35 HB and 104 P were monitored. Local catheter infection rates for HB and P were respectively 0.18 and 0.03 per 100 catheter days. Catheter-related sepsis rates for HB and P were respectively 0.11 and 0.07 per 100 catheter days. During the course of the study 6 out of 26 HB (23.1%) had documented exit site infections. In June 1991 the frequency of dressing changes was increased from once per week to three times per week as an intervention measure. Subsequently, local lib catheter infection rates decreased by 31%, and no catheterassociated sepsis was noted. Further data need to be evaluated to determine the optimal frequency of dressing changes for HB catheters.
NEEDLE-FREE SYSTEM ELIMINATES IV-RELATED NEEDLESTICKS. D. lnglot, RN, BSN,* L. Cornman, RN. McKeesport Hospital, McKeesport, PA. Accidental needlesticks pose the biggest risk of employee exposures to bloodborne diseases, and one study concluded that 80% of exposures to HIV are through needlesticks. In 1985. McKeesport Hospital experienced 105 such injuries, 25 (24%) of which were intravenous (IV)-related. This confirmed a perceived problem with IV procedures generally and adminisu-ation of heparin-leck and piggyback medications specifically. In 1987, the Infection Control and Employee Health Departments instituted a policy for reporting on-the-job needlesticks immediately after the accident occurred. In 1988. needlestick injuries which were IV-related were 20%, and in 1989 they were 17%. From June through December 1989, when a needle-free IV system was adopted hospitalwide, 29 needlestick injuries were reported, only one of which was IV-related. Since 1990, IVrelated needlesticks have remained zero. McKeesport Hospital felt that it was necessary to implement safer medical devices relative to IV therapy to protect all health care workers from high risk situations. The program at McKeesport Hospital demonstrates that engineering controls are effective in significantly reducing needlestick injuries. This is not to suggest that education and Universal Precautions do not play an important role. Safer medical devices are necessary not only to protect health care workers from HBVand HIV-infected patients, but just as importantly, to protect them from themselves.
Abstracts PERCEIVED RISK OF NEEDLESTICK INJURIES AND HEPATITIS B VACCINE AMONG HOSPITAL NURSES. N. Schuler, RN, MA, CIC,* W. Ryan, Phi), RN, D. Cryer, Phl). University of Northern Iowa, Cedar Falls, IA and Covenant Medical Center, Waterloo, IA. In an attempt to determine the reasons for not reporting needlestick injuries (NSI) and whether vaccination against hepatitis B virus (HBV) influenced behavior after NSI, all 640 members of the nursing staff at a Midwest community hospital were asked to complete a questionnaire about the number of NSI they experienced over a 2.5-year period, their behaviors following each NSI, and their reasons for those behaviors. Two hundred fifteen nurses completed the questionnaire (34% of population). Of these, 60 (28%) reported one or more NSI during the study period. Ninetythree percent of those nurses who experienced NSI had received HBV. Major reasons reported by nurses for not reporting NSI (verbally and]or in writing per hospital policy) included: not enough time (53%), no risk of infection due to having received HBV (29%), not important (12%), and unfamiliarity with reporting procedures (12%). Of the 60 nurses who experienced NSI, 49% reported they did not seek any medical treatment post NSI. Major reasons for failing to seek medical treatment post NSI included: inconvenience (39%) and perceived lack of risk for infection due to having received HBV (30%). Among this sample of hospital nurses, a significant number did not report NSI or seek medical treatment post NSI due to a perceived decreased risk for infection, because they had received HBV. The results of this study indicate a need for inservice education for hospital nursing staff regarding the risks associated with NSI and the importance of early reporting and treatment.
IMPACT OF A THREE=YEAR COMPREHENSIVE PLAN OF ANALYSIS OF NEEDLE,STICK INJURIES AND THE INSTITUTION OF SAFETY EQUIPMENT BASED ON THAT ANALYSIS. J. Shuck, RN, BSN, CIC,* N. Ran, MD. Ualontown Hospital, Uniontown, PA. In January 1989 the Infection Control Department at Uniontown Hospital (230-bed general hospital) devised a plan to reduce needlesticks which included in-depth analysis, accountability both individually and departmentally and evaluation of new safety equipment designed to reduce needlesticks. 1. An individual questionnaire was devised to be completed by employees after needlestieks asking specific questions about how injury occurred and equipment involved. Needle safety tips were also added to the form with the idea that employees would be more receptive just following their own exposure. 2. Quarterly needlestick summary reports were sent to departments requiring written recommendations for prevention from departments having three or more needlesticks in one quarter. Also, counseling was required of managers in some individual situations (example: needle in garbage can). 3. Yearly summaries were done of equipment and procedures involved in needlesticks as well as the cost of the needlestick protocol. 4. Cost comparison was done of present equipment to similar equipment with safety devices and analysis done of cost difference compared to needlestick protocol cost. 5. By demonstration of actual cost savings if needlesticks were reduced, the BD safety syringe was approved for use in August of 1990 and the Baxter NeedleLess IV System in December of 1990. Results: Needlestick injuries were reduced from 86 in 1989 to 65 in 1990 (24% decrease) to 28 in 1991 (57% decrease from 1990 and 67% decrease from 1989). With diligent analysis of needlestick injuries, individually, departmentally and by Infection Control, and application of this information to decision making regarding safety equipment, our needlesticks were reduced 67% in three years.
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A CLINICAL INDICATOR FOR PEDIATRIC ONCOLOGY PATIENTS: PROSPECTIVE MONITORING FOR INFECTIONS ASSOCIATED WITH HICKMAN/BROVIAC CATHETERS AND IMPLANTABLE PORTS. J. Umphrey, MT (ASCP), MPH,* J. Tan'and, MD, I. Raad, MD. University of Texas M.D. Anderson Cancer Center, Houston, TX. With more intensive chemotherapy comes the significant need for ease of administration of chemotherapy and blood products to the pediatric oncology patient. Central venous catheters ease the task and are also crucial to supportive care. In 1989 concern was expressed that there were unusually high numbers of patients with central venous catheter-associated sepsis. The high risk nature of these patients, along with our lack of baseline infection rates, led to the development of this monitoring activity. From July 1989 through October 1991, all patients having surgical placement of a Hickmnn or Broviac (HB) catheter, or an implantable port (P) under general anesthesia were prospectively monitored for catheter-associated infections until the time of catheter removal or November 30, 1991. Standardized data collection forms were collected for all patients which included documentation of infectious complications. Surveillance yielded the following results: 35 HB and 104 P were monitored. Local catheter infection rates for HB and P were respectively 0.18 and 0.03 per 100 catheter days. Catheter-related sepsis rates for HB and P were respectively 0.11 and 0.07 per 100 catheter days. During the course of the study 6 out of 26 HB (23.1%) had documented exit site infections. In June 1991 the frequency of dressing changes was increased from once per week to three times per week as an intervention measure. Subsequently, local lib catheter infection rates decreased by 31%, and no catheterassociated sepsis was noted. Further data need to be evaluated to determine the optimal frequency of dressing changes for HB catheters.
NEEDLE-FREE SYSTEM ELIMINATES IV-RELATED NEEDLESTICKS. D. lnglot, RN, BSN,* L. Cornman, RN. McKeesport Hospital, McKeesport, PA. Accidental needlesticks pose the biggest risk of employee exposures to bloodborne diseases, and one study concluded that 80% of exposures to HIV are through needlesticks. In 1985. McKeesport Hospital experienced 105 such injuries, 25 (24%) of which were intravenous (IV)-related. This confirmed a perceived problem with IV procedures generally and adminisu-ation of heparin-leck and piggyback medications specifically. In 1987, the Infection Control and Employee Health Departments instituted a policy for reporting on-the-job needlesticks immediately after the accident occurred. In 1988. needlestick injuries which were IV-related were 20%, and in 1989 they were 17%. From June through December 1989, when a needle-free IV system was adopted hospitalwide, 29 needlestick injuries were reported, only one of which was IV-related. Since 1990, IVrelated needlesticks have remained zero. McKeesport Hospital felt that it was necessary to implement safer medical devices relative to IV therapy to protect all health care workers from high risk situations. The program at McKeesport Hospital demonstrates that engineering controls are effective in significantly reducing needlestick injuries. This is not to suggest that education and Universal Precautions do not play an important role. Safer medical devices are necessary not only to protect health care workers from HBVand HIV-infected patients, but just as importantly, to protect them from themselves.
Abstracts PERCEIVED RISK OF NEEDLESTICK INJURIES AND HEPATITIS B VACCINE AMONG HOSPITAL NURSES. N. Schuler, RN, MA, CIC,* W. Ryan, Phi), RN, D. Cryer, Phl). University of Northern Iowa, Cedar Falls, IA and Covenant Medical Center, Waterloo, IA. In an attempt to determine the reasons for not reporting needlestick injuries (NSI) and whether vaccination against hepatitis B virus (HBV) influenced behavior after NSI, all 640 members of the nursing staff at a Midwest community hospital were asked to complete a questionnaire about the number of NSI they experienced over a 2.5-year period, their behaviors following each NSI, and their reasons for those behaviors. Two hundred fifteen nurses completed the questionnaire (34% of population). Of these, 60 (28%) reported one or more NSI during the study period. Ninetythree percent of those nurses who experienced NSI had received HBV. Major reasons reported by nurses for not reporting NSI (verbally and]or in writing per hospital policy) included: not enough time (53%), no risk of infection due to having received HBV (29%), not important (12%), and unfamiliarity with reporting procedures (12%). Of the 60 nurses who experienced NSI, 49% reported they did not seek any medical treatment post NSI. Major reasons for failing to seek medical treatment post NSI included: inconvenience (39%) and perceived lack of risk for infection due to having received HBV (30%). Among this sample of hospital nurses, a significant number did not report NSI or seek medical treatment post NSI due to a perceived decreased risk for infection, because they had received HBV. The results of this study indicate a need for inservice education for hospital nursing staff regarding the risks associated with NSI and the importance of early reporting and treatment.
IMPACT OF A THREE=YEAR COMPREHENSIVE PLAN OF ANALYSIS OF NEEDLE,STICK INJURIES AND THE INSTITUTION OF SAFETY EQUIPMENT BASED ON THAT ANALYSIS. J. Shuck, RN, BSN, CIC,* N. Ran, MD. Ualontown Hospital, Uniontown, PA. In January 1989 the Infection Control Department at Uniontown Hospital (230-bed general hospital) devised a plan to reduce needlesticks which included in-depth analysis, accountability both individually and departmentally and evaluation of new safety equipment designed to reduce needlesticks. 1. An individual questionnaire was devised to be completed by employees after needlestieks asking specific questions about how injury occurred and equipment involved. Needle safety tips were also added to the form with the idea that employees would be more receptive just following their own exposure. 2. Quarterly needlestick summary reports were sent to departments requiring written recommendations for prevention from departments having three or more needlesticks in one quarter. Also, counseling was required of managers in some individual situations (example: needle in garbage can). 3. Yearly summaries were done of equipment and procedures involved in needlesticks as well as the cost of the needlestick protocol. 4. Cost comparison was done of present equipment to similar equipment with safety devices and analysis done of cost difference compared to needlestick protocol cost. 5. By demonstration of actual cost savings if needlesticks were reduced, the BD safety syringe was approved for use in August of 1990 and the Baxter NeedleLess IV System in December of 1990. Results: Needlestick injuries were reduced from 86 in 1989 to 65 in 1990 (24% decrease) to 28 in 1991 (57% decrease from 1990 and 67% decrease from 1989). With diligent analysis of needlestick injuries, individually, departmentally and by Infection Control, and application of this information to decision making regarding safety equipment, our needlesticks were reduced 67% in three years.
109