Sue J Kim-Saechao1, Earl Almario2, Zachary A Rubin3. 1. Division of Vascular and Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles Medical Center, Los Angeles, CA. Electronic address: suesaechao@yahoo.com. 2. Division of Vascular and Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles Medical Center, Los Angeles, CA. 3. Department of Clinical Epidemiology and Infection Prevention, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA.
Abstract
BACKGROUND: Peripherally inserted central catheters (PICCs) removed prematurely for unconfirmed infection or thrombosis lead to subsequent reinsertions and associated complications. To improve clinical quality, a mandatory electronic communication tool (MECT) based on clinical practice guidelines was mandated for all inpatient adult PICCs in an academically affiliated tertiary medical center. This MECT facilitated early communication and specialized evaluation with the PICC team for any complications related to PICCs. METHODS: A historical cohort study was conducted. Quality and cost measurements for 200 PICCs postinstitution of a MECT were compared with 200 PICCs 12 months prior. PICC removal and complication rates were compared for the 2 cohorts. RESULTS: Significant outcomes included a central-line associated blood stream infection rate that changed from 1.38/1,000 catheter days to 0/1,000 catheter days, 0 provider-led premature PICC removals, an overall 84% decrease in premature PICC removals (from 16%-2.5%; P < .0001), a decrease in the total complication rate from 45.5%-24% (P < .0001), and 25% reduction in radiology costs. CONCLUSION: A novel infection prevention approach leveraging a MECT resulted in 0 central line-associated bloodstream infections and provider-led premature PICC removals.
BACKGROUND: Peripherally inserted central catheters (PICCs) removed prematurely for unconfirmed infection or thrombosis lead to subsequent reinsertions and associated complications. To improve clinical quality, a mandatory electronic communication tool (MECT) based on clinical practice guidelines was mandated for all inpatient adult PICCs in an academically affiliated tertiary medical center. This MECT facilitated early communication and specialized evaluation with the PICC team for any complications related to PICCs. METHODS: A historical cohort study was conducted. Quality and cost measurements for 200 PICCs postinstitution of a MECT were compared with 200 PICCs 12 months prior. PICC removal and complication rates were compared for the 2 cohorts. RESULTS: Significant outcomes included a central-line associated blood stream infection rate that changed from 1.38/1,000 catheter days to 0/1,000 catheter days, 0 provider-led premature PICC removals, an overall 84% decrease in premature PICC removals (from 16%-2.5%; P < .0001), a decrease in the total complication rate from 45.5%-24% (P < .0001), and 25% reduction in radiology costs. CONCLUSION: A novel infection prevention approach leveraging a MECT resulted in 0 central line-associated bloodstream infections and provider-led premature PICC removals.
Authors: Ruth-Alma N Turkson-Ocran; Erin M Spaulding; Susan Renda; Vinciya Pandian; Hannah Rittler; Patricia M Davidson; Marie T Nolan; Rita D'Aoust Journal: J Clin Nurs Date: 2020-08-19 Impact factor: 4.423