Catheter Related Blood Stream Infection Essay Example | Topics and Well Written Essays - 1500 words

Catheter Related Blood Stream Infection - Essay Example Guidelines for the prevention of (CRBSIs) have been formulated by CDC. These are targeted at the intensive care personnel who are involved in the insertion of these catheters and post insertion management and care of these catheters, particularly the nursing staff. It is proposed that in addition to the existing guidelines, this study will provide ample evidence for the use of PICCs in ICU setting to reduce the rate of CRBSI. Almost 12 years back, the use of PICCs was highly favored for cost and safety considerations by a study (Ng et al, 1997). The advantages of PICCs include ease of bedside placement, placement even by non-physicians and a relatively lower risk of complications. Complications of PICCs were studied in 351 patients and were identified to be infection related, phlebitis, vein thrombosis, PICC occlusion, broken or leaking catheter or dislodgement of the catheter (Walshe et al, 2002). However, even the authors concluded that because of their convenience and easily managed complications they should be continued to use. 200 prospective studies were analyzed systematically and it was determined that PICCs used in inpatients (2.1/ 1000 catheter days) had a slightly lower rate of CRBSIs than standard non cuffed and non medicated CVC s placed in subclavian or internal jugular vein(2.7 BSIs /1000 catheter days)(Maki, Kluger, & Crinch, 2006). Whereas, Safdar and Maki (2005) found that CRBSI with PI CCs was higher than some of the other CVCs. Thus, more studies are warranted to compare CRBSI rates of PICCs and CICCs and establish a lower rate of infection of PICCs. Study Design and Population The study utilized a central-line database retrospectively, one year prior to and 3 years after the introduction of hemodynamic monitoring with PICCs in a closed, medical-surgical, 20-bed intensive care unit and a 10-bed intermediate care unit of a tertiary-care academic medical institution. CRBSI rates were compared for a 12-month control period and a 36-month intervention period with open-ended PICCs. Thus, it was a retrospective analysis of an interventional study (Patel et al, 2007). 2,474 central vascular catheters were inserted in 1788 critically ill patients (21,919 catheter-days). ). A total of 6210 CICC catheter-days and 15,709 PICC catheter-days were analyzed (Patel et al, 2007). The primary outcome variable was the rate of CRBSI and this was defined as "isolation of the same organism (defined by species and antimicrobial susceptibility pattern) from the colonized catheter (>15 colony-forming units) and one or more peripheral blood cultures within 48 hours in a patient with no alternative source of bacteremia" (CDC, 2002). Since, the primary outcome measure was clearly defined, changes in the values were analyzed statistically and reliability was ensured. However, the blinding status so far as the group allocator or the body who assessed the results is not clear. What indicated the use of PICCs in most of the patients while some still had CICCs in the later years of the study is also not clear. Was