A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hemopoietic stem cell transplant ward.

BACKGROUND: Some catheter-related bloodstream infections originate from catheter connectors; therefore, improved antisepsis of these might be expected to reduce the incidence of such infections. METHODS: In this observational before/after study at a pediatric tertiary referral hospital, inpatients up to 16 years old undergoing hemopoietic stem cell transplants were studied. Catheter connection antisepsis was changed from 70% isopropanol alone to 2% chlorhexidine in 70% isopropanol. Numbers of catheter-related bloodstream infections before and after the change were monitored as were the numbers of catheter days experienced by patients. RESULTS: The infection rate before the change was 12 per 1000 catheter-days, and, following the change, this fell to 3 per 1000 catheter-days (P=.004). Similar falls followed the introduction of chlorhexidine to other wards. CONCLUSION: The introduction of chlorhexidine was followed by a profound, sustained fall in catheter-related infections. The results support the 2007 United Kingdom guidelines recommending 2% chlorhexidine in 70% isopropanol as a disinfectant of needleless connectors and hubs of central venous catheters.

Navigating the maze: parents' views and influence on a paediatric haematology and oncology day care service.

AIM: To examine with families their views on the service they receive in a Paediatric Haematology/Oncology Day Care Unit. BACKGROUND: National policy emphasises the importance of involving children, young people and families in the planning of services they are receiving. To be responsive to real, as opposed to perceived needs, health care professionals are actively seeking ways to capture the voice of the families they care for through a process of consultation and action. DESIGN: Focus groups. METHOD: A series of focus groups were undertaken with 16 families who were either on treatment or within six months of completion of treatment for acute lymphoblastic leukaemia. Tape- and note-based analysis was initially undertaken and the data sorted by means of an overview grid. Data were then analysed by the research team through comparison and agreement of final themes. RESULTS: The majority of families were satisfied with the care they received. Six themes are described that capture their combined thoughts on their overall experience; navigating the maze, communication, continuity of care, environment, waiting and organisation of care. CONCLUSIONS: Focus groups are an effective means of obtaining data from service users. Group discussion allowed for the sharing and development of ideas to be incorporated into developments within the service. RELEVANCE TO CLINICAL PRACTICE: Increasingly, children, young people and their families are being cared for within Paediatric Haematology/Oncology Day Care units, it is, therefore, vital that this aspect of care is designed, co-ordinated and delivered around the needs of the family. This can only be achieved by listening to the stories of those families who use our service to confirm what it is that works well and what areas of care may need to be enhanced.

Strategies to reduce the risk of needle and sharps injuries.

Needle or sharps injuries are common, underreported and often preventable (Department of Health, 2004). This article describes when, how and why these injuries occur and who is at risk. It provides an overview of recent legislation and outlines strategies to minimise risks.

Audit of peripheral venous cannulae by members of an i.v. therapy forum.

This article describes a clinical audit of peripheral venous cannulae (PVC) undertaken by members of a national intravenous therapy forum. PVC care was reviewed using the RCN 'Standards for Infusion Therapy' and the Department of Healh's 'Winning Ways' report, action area 2 (DH, 2003; RCN, 2003) to define best practice. Data were collected by members of the forum and submitted for analysis by the members' coordinator. The findings of the audit highlighted several areas for improvement in PVC care. The most significant finding was poor documentation of the insertion of the cannula. An additional concern was that the person who performed the cannulation could not be identified for 236 (37.7%) of PVC audited. Draft recommendations with strategies for implementation have been proposed and feedback sought from participants with plans to re-audit in 2007.

Vascular access: indications and implications for patient care.

This overview of the vascular access devices available for adult patients explains how careful selection and management of the device can minimise the complications associated with infusion therapy.