Catheter strategy sticks it to infection rates
Guidelines also stress proper staff education
Because intravenous therapy is handled by home care personnel, Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines on prevention of intravenous catheter infections especially is applicable to home care, suggests Michele L. Pearson, MD, medical epidemiologist for the CDC’s Division of Healthcare Quality Promotion in Atlanta.
"[These are] some very specific recommendations, including the use of a 2% aqueous chlor-hexidine gluconate solution to prepare catheter insertion sites," she says.1
Products containing chlorhexidine have been available in the United States only since July 2002 when the Food and Drug Administration approved the 2% solution for skin antisepsis, she adds.
The catheter guidelines also stress the importance of educating staff as to the proper procedure for hand hygiene, skin antisepsis, and insertion of catheters, Pearson points out.
"Our findings show that even short educational programs have reduced catheter-related infections by 30%," she says. Although the data studied by the guidelines’ authors were gathered from acute-care settings, the findings and recommendations are not exclusive to hospital settings, Pearson adds.
Sometimes, finding out what your infection rate is can be a challenge, but staff at Northwest Community Home Care in Arlington Heights, IL, have developed a process to identify patients at risk and follow up on infections that appear.
"Our admissions nurse fills out a form that lists possible risk factors for development of infections, then as nurses visit the patient, they look for symptoms of potential infections," explains Shannon Quaritsch, RN, BA, quality improvement specialist for Northwest Community Home Care.
Symptoms for which a nurse would look include fever, new antibiotic order, purulent drainage from a wound, change in odor or color of urine, or change in color or consistency of sputum. Once a potential infection is identified, the infection control supervisor evaluates the patient and contacts the physician.
The key to tracking infection rates and identifying ways to reduce infections was to have nurses turn in their intake reports as well as weekly infection control reports from regular visits, Quaritsch says.
Although employees are typically reluctant to report infections because they believe that an infection reflects badly on the care they are providing, she says that once the nurses saw how gathering the information actually helped them reduce infections, they asked for voice mail messages reminding them to send in the reports.
"As we’ve gathered data, we find that oftentimes we have to re-educate the family caregiver and even make the process of changing wound dressings easier so that they will perform the dressing changes on a regular basis," she says.
One month, a rise in the number of pressure ulcers in patients caused Quaritsch to look closely at the patients to determine the cause of the ulcers. "We discovered that all of the patients came from one particular nursing home, so we offered to conduct an inservice at the nursing home," she says.
The staff at Northwest Community also works with the hospital’s infection control department to identify the cause of infections as hospital-acquired or community-acquired, Quaritsch explains. By knowing where the infection began, treatment and prevention usually are more effective, she adds.
Infection control must be a continuous effort, Quaritsch points out. "We not only started our program with clear, well-defined guidelines based on scientific evidence, but we gathered baseline data prior to implementing our infection control program so we could evaluate its effectiveness."
Another key to success is to communicate results, she says. "Our infection control statistics are reported at all quarterly meetings, and I meet one on one with field nurses to go over the data."
Quaritsch also recommends setting priorities for the surveillance program by evaluating the patient population and focusing on the most typical infections. "In home care, we tend to see more pressure or other types of ulcers as well as post-op wound infections, but you also must look for urinary tract infections, bloodstream, and gastrointestinal infections. Also, involve an infectious disease specialist or infection control nurse in the development of your plan to add credibility."
[For more information, contact:
• Michele L. Pearson, MD, Medical Epidemiologist, Division of Health Quality Promotion, National Center for Infectious Disease, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Telephone: (404) 639-3311. E-mail: [email protected].
• Shannon Quaritsch, RN, Quality Improvement Specialist, Northwest Community Home Care, 3060 Salt Creek Lane, #110, Arlington Heights, IL 60005. Telephone: (847) 648-7855. E-mail: [email protected].]
Reference
1. O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR 2002; 51(RR10):1-26.
Infection Control Resources
For information about setting up infection control programs in home care:
• Infection Control in Home Care by Emily Rhinehart. A special issue of the Morbidity and Mortality Weekly Report published by the Centers for Disease Control and Prevention. The issue is available on-line at: www.cdc.gov/ncidod/eid/vol17no2/rhinehart.htm.
• Association for Professionals in Infection Control and Epidemiology, 1275 K St., N.W., Suite 1000, Washington, DC 20005-4006. Tele-phone: (202) 789-1890. Fax: (202) 789-1899. Web site: www.apic.org. The association offers Guidelines for the Prevention of Intravascular Catheter-Related Infections and Draft Definitions for Surveillance of Infections in Home Health Care on its web site. APIC also offers Home Care Handbook of Infection Control, a home-care-specific quick reference guide for infection control. The handbook is available for $29 for APIC members and $38 for nonmembers.
Because intravenous therapy is handled by home care personnel, Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines on prevention of intravenous catheter infections especially is applicable to home care, suggests Michele L. Pearson, MD, medical epidemiologist for the CDCs Division of Healthcare Quality Promotion in Atlanta.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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