Looking to gain some feedback on dressing types used out there. We have been trying to fight CLABSI rates here in our PICU. Let me just say that many things have been at play here! The consensus of administrative team was to change the dressing with ANY peel of the outer edges. When placed in areas of folds/flexion the very outer edges do sometimes become lifted (while the dressing remains occlusive to site). The PICC team has started doing more lines and we have been removing the IJs and Fem lines a lot sooner. This I know first hand it will help to reduce some of our issues. I have also stated to the EBP Team for CLABSI that IF the dressing is still occlusive we should not be routinely changing dressings for the slightest of peeling corner. Sometimes the nurses are changing them several times per day :( despite all my voiced concerns.
PLEASE HELP
This article may be helpful:
Dressing disruption is a major risk factor for catheter-related infections*
Jean-François Timsit, MD, PhD; Lila Bouadma, MD, PhD; Stéphane Ruckly, MSc; Carole Schwebel, MD, PhD; Maïté Garrouste-Orgeas, MD; Régis Bronchard, MD; Silvia Calvino-Gunther, RN; Kevin Laupland, MD;
Christophe Adrie, MD, PhD; Marie Thuong, MD; Marie-Christine Herault, MD; Sebastian Pease, MD;
Xavier Arrault, PharmD; Jean-Christophe Lucet, MD, PhD
IMHO, the first priority is to prevent any and all disruption of the dressing by using skin barrier solution. These solutions protect the skin and increase adherence and disruptiom. I agree that changing several times per day is not appropriate but any form is disruption, even a small area on what might be viewed as an insignificant corner, can quickly lead to totally non-adherent dressing. I would solve this problem by using these skin protectant solutions on every VAD, every patient, every time. Medical adhesive related skin injury (MARSI) is driving the need for these sollutions and is now included in the INS SOP. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861