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Increase in CR-BSI since the change over to neutral valve injection cap

 At the small community hospital I work at, I fought to get a neutral valve injection cap into the hospital since there has been a push to move away from heplock flushes. But since its introduction our central line infection rate has jumped considerably even with the introduction of pre-filled saline flush syringes during the year. We still use heplock for most patients but not for patients with low platelet counts and with HIT.

I met with the vendor who assures me it couldn't possibly be his product. We now are changing the injection caps twice weekly instead of Q 7days with dressing changes and are using direct -connect w/ patients receiving TPN.( The highest risk factor that was identified).  We have been using the biopatch for years on all of our central lines including PICC's.

What would be the best way to determine if it is indeed the injection cap that is the culprit or should I start shopping around for a split septum product and just assume it is the injection cap?

I too based my decision on the Ryder study.

Kathy Cutter, CRNI

 

lynncrni
You can look at the nurses

You can look at the nurses processes for scrubbing that needleless connector before each and every use. This is a critical component with all needleless connectors, but the split septum devices seem to be more "forgiving" when this step is not done or done poorly. You can scrub with an alcohol pad or use a CHG/IPA pad but this needs to be done for 15 seconds in all directions and all surfaces of the connector top and luer lock threads.

I would recommend direct hub to hub connection with all continuous infusions, but it is very good that you are doing it with PN.

You can talk to your lab and infection prevention specialist to determine if you can harvest the used connectors for culturing the internal segment somehow to see if they are growing organisms, however I would bet good money that all will produce some level of contamination. Biofilm has been confirmed to reach a steady state in these devices at 5 days, so more frequent change is good. If you can not manage such a clinical culturing study, you can simply switch to a split septum connector as the guidelines are now recommending. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Lynn, Thanks for your

Lynn,

Thanks for your reply,

We are gearing up for a back to basics "scrub the hub" and hand washing campaign to complement what is already being emphasized on Mandatory day offered quarterly.  We also have monitors that measure hand washing compliance and QA reporting on foam and soap dispenser usage. 

If our numbers don't improve back to our original low cr-sbi rate then I'll be shopping for a split-septum system.

Kathy

lynncrni
One other thought - what

One other thought - what about the use of IV administration sets for intermittent use? Those that are connected, disconnected, reconnected. How often are these changed? INS says 24 hours, CDC does not even distinguish between continuous and intermittent use. But CDC does say that all needleless connectors require entry with a sterile device. How do your nurses manage these sets between uses? The standards say they should be covered with a new sterile cap or new blunt plastic cannula. They should never be left open, and there is no evidence that attaching the male luer end to an injection site higher on the same set is acceptable. I have also seen these covered with the foil packet from an alcohol pad. There is no possible way that the male luer end is remaining sterile. It does not matter how well the needleless connector is scrubbed if the nurses are sticking a dirty set into it.

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

plsysinc
increased CR-BSI rates

You might want to also try a zero fluid displacement connector.  This type of connector was designed to protect the intraluminal fluid pathway.  It has been determined that a more comprehensive design approach that looks at various features needed for protection isa better than a less comprehensive approach that looks at just one or two.

 

Denise

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