A comparison of intravascular pressure monitoring system contamination and patient bacteremia with use of 48- and 72-hour system change intervals.

OBJECTIVE: To determine the incidence of culture positivity in intravascular monitoring systems by comparing 48- versus 72-hour intervals for flush solution, stopcocks, and catheters on removal. DESIGN: Prospective, quasi-experimental, random assignment. SETTING: Intensive care units of a midwestern university medical center and a community hospital. PATIENTS: Seventy-six critically ill adult patients, ranging in age from 24 to 96 years (X = 61.6), requiring arterial or pulmonary artery catheters. OUTCOME MEASURE: Culture positivity of flush solution, stopcocks, or catheter tips. INTERVENTION: Data collection was initiated at designated change intervals of 48- or 72-hours; cultures were taken of flush solution and stopcocks; catheter tip cultures were obtained on catheter removal. RESULTS: Chi-square analyses indicated that increasing the change interval to 72 hours resulted in no significant difference in culture positivity of catheter tips. However, the difference between the 48- and 72-hour groups in culture-positivity rates of stopcocks from arterial catheters was significant (1, N = 82) = 6.86, p less than 0.01. CONCLUSIONS: Our results showed that increasing the change interval to 72 hours did not increase the risk of catheter-associated infection or catheter-associated bacteremia. Chi-square analysis did not show an association between culture-positive stopcocks, the incidence of culture-positive catheter tips, entries into the system, or catheter-related bacteremia and a change interval that was increased to 72 hours. Thus, increasing the change interval to 72 hours does not increase the risk of infection.

Predicting effects of minimal invasive therapy.

OBJECTIVE: To estimate expected effects of minimal invasive therapy (MIT). DESIGN: We developed a structured questionnaire and sent it to 35 mainly senior academic surgeons considered leaders in MIT in the UK, USA, and Canada. We asked their opinions on which specific operations would be done by minimal invasive technique and the effects of this change on hospitals over the next 5 years. We used these responses to predict effects on hospitals of MIT. We also compared predictions against published data 2 years later. RESULTS: Respondents predicted 34 specific operations would be performed using MIT, and that 53% of the patients undergoing these operations would receive MIT procedure. This transformation would lead, in their opinion, to a decline of 10 million inpatient hospital days, a 62% decline of average length of stay for operations predicted amenable to MIT, and a resultant savings of $4.5 billion in the U.S. Comparable effects could be expected to occur in other countries. CONCLUSION: Many of the trends predicted by respondents are being borne out. If these trends continue, MIT will have profound effects on patients (clinical, quality of life function), providers (hospital utilization and financing, physician training), and payers (expenditures) in all countries if respondents' predictions about MIT and its impact are even reasonable accurate. Attention should be directed first to the hospital sector, given expected effects of changes of clinical service mix, revenues, and the need for different, and differently trained, personnel.

Intravascular medication delivery devices and monitoring systems.

This article presents a review of the current standards and the research of infection-control practice for medication delivery devices and monitoring equipment. The standards of the Centers for Disease Control and Prevention, Intravenous Nursing Society, and the Association for Professionals in Infection Control and Epidemiology, Incorporated, are reviewed and compared to the current research.

Factors associated with medication noncompliance in rural elderly hypertensive patients.

This study sought indicators of patient noncompliance with medications prescribed for hypertension. A sample of 62 elderly, rural hypertensive patients were interviewed regarding demographics, history and knowledge of hypertension, quality of life, the physician-patient relationship, drug use, and side effects encountered. A five-variable composite was able to detect the patients who were defined as noncompliant. The composite included: 1) number of chronic illnesses, 2) perceived amount of time the physician spends with the patient, 3) the patient's household composition, 4) family history of hypertension, 5) and whether hypertension affects work or home activities. More accurate identification of noncompliant patients sets the stage for interventions to improve compliance.

Infection related to intravascular pressure monitoring: effects of flush and tubing changes.

The optimal frequency for changing pressure monitoring tubing and flush solution that minimizes catheter-related infection and contains cost has not yet been established. We conducted a pilot study to examine the effects of three protocols on catheter-related infection: group I, change of flush solution and pressure monitoring tubing every 24 hours; group II, change of flush solution every 24 hours and change of pressure monitoring tubing every 48 hours; group III, change of flush solution and pressure monitoring tubing every 48 hours. Thirty critically ill patients were randomly assigned to one of the three protocols. Semiquantitative cultures of the solution from the flush bag and catheter tip were obtained. Intervening variables were documented: duration of cannulization, number of entries into the system, presence of other invasive devices, white cell count, patient's temperature, presence of preexisting infection, patient's age and diagnosis, use of steroids and antibiotics, and host risk factors for immunocompromise. All flush solution cultures were negative for growth. Incidence of catheter-related bacteremia was zero. The cultures of four catheter tips were positive for Staphylococcus epidermidis; none in group I, three in group II, and one in group III. The results of this pilot study suggest that there is no difference in the incidence of catheter-related infection whether the change interval for flush solution and pressure monitoring solution is 24 or 48 hours. However, further study with a larger sample is needed.

A nursing practice problem: failure to observe aseptic technique.

A study was conducted to assess nurses' adherence to a recently revised policy and procedure manual. Medical-surgical nurses (n = 217) were surveyed to assess their perceived ability to perform selected clinical procedures. A sample (n = 34) of respondents was then observed performing the procedures. Analysis of the 37 errors in performance revealed an unanticipated high number of errors (n = 33) in aseptic technique. Type of errors and projected reasons for their occurrence are given.