Study Overviews

Achieving Near-Zero and Zero: Who Said Interventions and Controls Don't Matter?

 

Donna Matocha, MSN, RN, CNRN, VA-BC.

Journal of the Association for Vascular Access 2013; 18 (3): 157-163.

Background:
Implementation of the Institute for Healthcare Improvement's Central Line Bundle in 2005 did not result in attainment of 0 central line-associated bloodstream infections (CLABSIs).

Purpose:
To establish process improvements to eliminate CLABSIs.

Methods:

Infection Prevention and Intravenous Therapy Departments at our institution formed a collaborative partnership in 2008 to eliminate CLABSIs. Staff education, daily surveillance, and implementing evidence-based practice into policies, protocols, and product selection were utilized. A study designed to capture and track multiple interventions from the beginning versus time was implemented.

Results:
There were a total of 7 CLABSIs over 5 years, which trended down by year from 3 to 2 to 1 to 1 to 0. The average annual CLABSI rate of infections per 1,000 catheter line days declined from 1.068 to 0.849 to 0.508 to 0.449 to 0.000. The full 3-year simple average from 2009 to 2011, after all of the key interventions were phased-in, was 0.3048.

Clinical Evaluation of the Sorbaview SHIELD Securement Device Used on Peripheral Intravenous Catheters in the Acute Care Setting.

 

Polly L. Flippo, RN, MSN, CMSRN, Jayne Lee, RN, MPH, CIC

Journal of the Association for Vascular Access 2011; 16 (2): 95-102

Purpose:
The purpose of this study at FirstHealth Moore Regional Hospital (MRH) was to perform a clinical evaluation of the SorbaView SHIELD dressing to demonstrate the anticipated cost savings of the device related to the reduction of unscheduled restarts. The study also sought to demonstrate clinician satisfaction with the dressing.

Results:

  • 109 patients were enrolled.
  • There were only 2 episodes of dislodgment, 1 episode of infiltration, 1 occlusion and 3 IVs that leaked.
  • 86% of the nurses surveyed rated the securement dressing as good to excellent.
  • 91.5% of the patients IV's made it to either discharge or 96 hours.
  • The annual cost savings over the hospitals previous product was $120,000.

Clinical Trial of a New All-in-one Peripheral-short Catheter.

 

Elizabeth E. McNeill, RN, BSN, MA, CCRN, Nicole L. Hines, RN, BSN, CIC, Regina Phariss, RN

Journal of the Association for Vascular Access 14.1 (2009): 46-51.

Purpose:
The objectives of the study at this 851 bed hospital in the Covenant Health System were to understand current peripheral IV practices within the hospital and evaluate a closed IV catheter system with the use of the SorbaView dressing and HubGuard.

Results:

  • There was no hospital-wide standard for the securement of catheters. 62.5% failed within the first 24 hours.
  • Only 9.5% made it to 72 hours or longer.
  • After implementation with the new catheter and dressing/securement unscheduled restart rates dropped to just 28%.
  • 90% of the clinicians who used the SorbaView/HubGuard combination preferred it over their previous securement.

Observational study of SorbaView 2000, SorbaView Ultimate and SecureView Port AFZ Dressings used on Central Venous Catheters in Eleven Italian Oncology, Hematology and Pain Centers.

 

L. Orsino (Study Manager), et al.

Journal of the Association for Vascular Access 14.1 (2009): 14-19.

This study was performed at eleven Italian Oncology, Hematology and Pain centers.

Purpose:
The intention of this observational study was to study the efficacy and tolerability of the latest generation of dressings introduced in Italy. Specific dressing were SorbaView 2000, SorbaView Ultimate and SecureView Port AFZ dressings. The dressings have similar constructions with some exceptions for each type of use.

Results:
The study was performed on 435 patients.

Of the 435 patients enrolled:

  • In total 1391 dressings were applied. 1291 (92.66%) adhered for the prescribed therapy, 94 (6.75%) detached but did not need to be replace and only 8 were completely detached (0.57%).
  • 365 (83.9%) expressed approval of the dressings by the following measures:
    • Ability to perform daily hygiene
    • Patients could carry out daily activities and sports activities
    • Patients reported the absence of reactions where they have had problems with other dressings
    • There was an improvement in their overall quality of life.

Central Venous Catheter Dressings Put to the Test

 

Trotter BS, Brock JL, Schwaner S, Conaway M, Burns SM.

American Nurse Today. 2008;3(4):43-44.

Purpose:
The purpose of this study was to compare the most common Central Venous Catheter dressing method, tape and gauze, to two other methods.

The objectives were to determine:

  • Dressing condition
  • Was the dressing prone to soiling
  • Adherence
  • Did the dressing stay intact?
  • Nursing time
  • How much time was needed to perform the dressing change

The three methods were:

  • Tape and gauze
  • Tegaderm and gauze
  • SorbaView dressing.

224 dressing applications were examined:

  • 59% were PICCs
  • 26% were Non-tunneled CVC catheters
  • 15% were suture Hohn catheters

Results:

  • The SorbaView dressing remained intact over 7 days 94% of the time.
  • The estimated cost savings in materials alone was $35,000.

Evidence: The First Word in Safe I.V. Practice

 

Winfield C RN, Davis S BSN RN, et al.

American Nurse Today. May 2007 Vol. 2 Num. 5

This study took place at University of Virginia Health System.

Purpose:
The authors set out to prove the current institutional method for covering and securing catheters was outdated, prone to complications and in conflict with current standards and guidelines for peripheral IV care.

The current method was to place non-sterile, clear tape over the IV insertion site without sterile gauze for all surgical procedures. Post operatively an extension set was added and the dressing changed to either sterile gauze and tape dressing or transparent dressing.

Methods:
The authors hypothesized that using tape and gauze for securing catheters was outdated, time-consuming, risked exposure to blood, created a risk for dislodgment and was infection prone.

They examined 4 methods for securement:

  • Nonsterile tape over the site
  • A "U" taping with gauze
  • A Tegaderm dressing
  • A VersaDerm dressing.

105 patients were studied.

Results:
The VersaDerm Method was shown to be the best overall method for stabilization, consistency, cost-savings and ease of use.

Basic Science - Decreased Costs/Improved Outcomes With Standardized Intravenous Equipment

 

Elayne Penney-Timmons, RN, OGS, CRNI

Journal of the Association for Vascular Access 10.1 (2005): 20-23.

This 700 bed facility in the Midwest engaged in a product trial as evidence for a change in the products and process for inserting a peripheral IV catheter.

The trial was based on Centurion single-use IV start kit.

Purpose:
The facilities objectives were to:

  • Standardize IV start materials and procedures
  • Reduce phlebitis rates
  • Accomplish objectives with existing staff

Methods:
Data was collected over six month intervals with the goal of approximately 250 random assessments per period from 2002-2004.

Nurses were not informed of upcoming assessments.

Results:

  • 1345 assessments were performed
  • The infiltration rate was ZERO
  • The phlebitis rate was nearly eliminated, started in 2002 at 3.79% down to 0.40%
  • Nursing time was reduced from 25 minutes per procedure to 15 minutes per procedure
  • Because of these improvements the dwell time was extended from 72 to 96 hours
  • Patients had few site complications and unscheduled restarts
  • This led to an annual cost savings of $188,640

Seven Day Dwell Times for Vascular Access Service Exit Site Dressings

 

Lee, M.

INS National Convention Poster Presentation May 7, 2002.

From November 1, 1999 to July 12, 2002 IV Management Services, a vascular access consulting company in Phoenix, AZ, began an evaluation of the SorbaView and the SorbaView 2000 window dressings.

These dressings represent a hybrid in transparent semi-permeable membrane dressings. They are composed of an occlusive polyurethane film layer that is vapor transmissible with a non-adherent absorbent pad and a comfortable non-woven cloth border. This design allows for excess moisture to be wicked away from the Vascular Access Device exit site and creates an occlusive barrier to external contamination.

The SorbaView 2000 came to market later in the study starting in January 2002 until July 2002. It represented a significant innovation in the previous SorbaView. By reorganizing the layers of the dressing it improved the occlusive properties of the dressing.

The Objective:

  • Would the dressing stay intact and occlusive for 7 days
  • Assess for the incidence of exit site infection
  • Establish guidelines based for the use of the dressing across a variety of health care settings

Methods:

  • 576 patients were enrolled in the evaluation, with a total of 1961 assessments of the dressings.
  • The majority of the devices dressed were PICCs (80%) for the SorbaView and (89%) for SorbaView 2000.
  • The dressings were used in 32 facilities ranging from teaching hospitals to home health care.

Results:

  • The SorbaView was considered intact over a 7 day period 82% of the time.
  • The SorbaView 2000 was considered intact over a 7 day period 93% of the time.
  • Exit site infection rate was 1.4 per 1000 catheter days.
  • The dressing demonstrates the incredible durability of the SorbaView line. Integrating protection, absorbency and comfort into one package.

Three Years Experience in Implementing HICPAC Recommendations for The Reduction of Central Venous Catheter-Related Blood Stream Infections.

 

Garcia R, Jendresky L, Landesman S, Maher A, Nicolas F.

Lecture, Jan 28, 2005 APIC, Tampa, FL.

This study took place at a large teaching hospital in metropolitan NY.

Purpose:

The objectives of the study where to determine the effectiveness of implementing various evidence based interventions in reducing infection the incidence of CR-BSI.

The pre-intervention rate of infection from January thru December 1999 was 15.0 CR-BSI cases per 1,000 catheter days.

Methods:
The following interventions were employed:

  • In 2000, focused education reduced the infection rate to 6.4 CR-BSI cases per 1,000 catheter days.
  • In 2001, Conversion to a silver-platinum (Vantex) catheter resulted in a decrease to 3.3 CR-BSI cases per 1,000 catheter days.
  • In 2001, the use of max barrier precautions was implemented with a slight initial increase in infections.
  • BUT with the implementation in 2002 of a CHG-70% isopropyl alcohol skin prep reduced the rate to 1.6 CR-BSI cases per 1,000 catheter days.

Results:

  • The total infection rate was reduced by 89.3% by implementing these four basic interventions.
  • 237 CR-BSI's were avoided by implementing the above mentioned interventions. The estimated annual savings impact was $2,519,084 to $4,088,000.

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