Os conectores sem agulhas foram introduzidos para redução de incidência de acidentes pérfuro-cortantes nos profissionais da área da saúde e a literatura apresenta evidências irrefutáveis sobre este aspecto. No entanto, não há evidências conclusivas sobre as vantagens do conector sem agulha para o paciente, no que se referem aos índices de infecção de corrente sanguínea relacionada ao cateter venoso central. Este estudo tem como objetivo evidenciar o impacto do uso de conectores sem agulhas para sistema fechado de infusão na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central por meio de revisão sistemática, desenvolvida conforme as recomendações propostas pela Colaboração Cochrane. A estratégia de busca nas bases de dados eletrônicas utilizou os componentes do PICO: População (estudos com pacientes em uso de cateter venoso central, independente de idade, sexo, etnia e serviço de saúde vinculado); Intervenção (uso de conectores de sistema fechado sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Comparação (uso de oclusores, conectores de sistema fechado com ou sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Outcome-desfecho (infecção de corrente sanguínea, contaminação do canhão, contaminação microbiana, infecção de corrente sanguínea relacionada ao cateter). As bases eletrônicas investigadas foram: PubMEDLINE, OVID, EMBASE, LILACS, CINAHL. Também foram avaliadas as referências bibliográficas dos estudos incluídos. Os resultados estão apresentados em três etapas: caracterização do processo de seleção dos estudos encontrados na busca; caracterização dos estudos incluídos para a revisão sistemática (RS); avaliação de qualidade e força da evidência dos estudos incluídos segundo a Escala de Jadad e a Escala de avaliação de qualidade dos estudos na área de Controle e Prevenção de Infecção de Corrente Sanguínea Relacionada ao cateter Venoso Central. A amostra desta revisão sistemática constitui-se de 14 estudos, e quatro investigaram somente conectores sem agulhas. Foram encontrados 6 ensaios clínicos controlados randomizados, 4 coortes, 3 caso-controle e 1 resultado terapêutico. A infecção de corrente sanguínea relacionada ao cateter venoso central foi o desfecho de 9 estudos. Seis apresentaram diferenças a favor do conector valvulado; 04 a favor do conector puncionável com cânula; 01 a favor do conector puncionável com agulha; 01 a favor do conector valvulado com pressão positiva e 02 a favor do dispositivo usado antes da troca. A heterogeneidade dos estudos quanto aos desenhos de pesquisa, as características das populações e os fatores de riscos controlados e os resultados, não permitem a realização de meta-análise, contudo, é possível afirmar, com base nos quatro melhores estudos encontrados, que a implantação de conectores sem agulhas, quer valvulados ou com injetor pré-furado, com manutenção de sistema fechado de infusão, apresentam impacto positivo relacionado à menor contaminação do canhão do cateter ou na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central / Needleless connectors were introduced to reduce the incidence of needlestick injuries in health professionals and according to the literature their effectiveness is irrefutable. However, there is no conclusive evidence on the advantages of needleless connectors for patients with regard to bloodstream infection rates from the use of central venous catheters. The objective of this study was to determine the impact of the use of needleless connectors in closed infusion systems on the occurrence of bloodstream infections related to the use of central venous catheters by conducting a Cochrane systematic review. The strategy for searching electronic databases employed the components of the PICO model: Population (studies of patients using central venous catheters, regardless of age, sex, race and associated health service); Intervention (use of closed needleless connector systems, with and without valves, with and without positive pressure); Comparison (use of plugs, closed system connectors with and without needles, with and without valves, with and without positive pressure); Outcome (bloodstream infection, cannula contamination, microbial contamination, bloodstream infection related to catheter). The electronic databases investigated were: PubMEDLINE, OVID, EMBASE, LILACS and CINAHL. Bibliographical references of the studies included were also evaluated. The results are presented in three stages: characterization of selection process for studies found in the search; characterization of studies included in the systematic revision; evaluation of quality and strength of evidence for studies included according to the Jadad Scale and the scale of quality of studies in the control and prevention of bloodstream infections related to central venous catheters. The sample of this systematic review was made up of 14 studies of which 4 investigated only needleless connectors. We found 6 randomized control clinical trials, 4 cohort, 3 case-control and 1 therapeutic result. Bloodstream infection related to central venous catheters was the outcome for 9 studies. Six presented differences regarding the valved connector; 04 in favor of the puncturable connector with cannula; 01 in favor of the puncturable connector with needle; 01 in favor of the valved connector with positive pressure and 02 in favor of the device used before the change. The heterogeneous nature of the studies with regard to design, population characteristics and controlled risk factors and results prevented a meta-analysis. However, it is possible to state, based on the four best studies found, that the introduction of needleless connectors, whether valved or puncturable with cannula, coupled with a closed infusion system, presented a positive impact on lowering contamination of catheter cannulae and on the occurrence of bloodstream infection related to central venous catheters

The aim of this study was to determine the prevalence of extended-spectrum b-lactamase (ESBL)- producing Klebsiella pneumoniae isolated from urinary tract and bloodstream infections in a rural hospital in Manhic¸a, Mozambique. ESBLs were investigated among ceftriaxone-non-susceptible K. pneumoniae clinical isolates recovered between 2004 and 2009. Characterisation of blaCTX-M, blaSHV, blaOXA and blaTEM genes was performed by PCR and sequencing. Epidemiological relationships were established by phylogenetic analysis, repetitive extragenic palindromic PCR (REP-PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), whilst plasmid transferability was evaluated by conjugation. In addition,the presence of class 1 and 2 integrons was studied.A total of 19 K. pneumoniae were analysed. The blaCTX-M-15 gene was found in all strains. Other ESBL genes were found concomitantly, including blaSHV-5, blaSHV-2, blaSHV-2A, blaSHV-12 and blaSHV-38. In addition, other b-lactamases such as blaTEM-1 and blaOXA-30 were also detected. REP-PCR identified 15 different epidemiological profiles. MLST analysis also showed great variability of sequence types. The blaCTX-M-15 gene showed a high transfer capacity. The presence of class 1 integrons was high. High levels of multidrug resistance were also found. In conclusion, these data show the dominance of the CTX-M-type ESBL, particularly CTX-M-15, supporting its worldwide dissemination, including in areas with limited access to third-generation cephalosporins. This finding is a matter of concern for clinical management as third-generation cephalosporins are an alternative for treating severe cases of multidrug-resistant infections in this community. / Revisión por pares

Acute bacterial skin and skin structure infections (ABSSSI) are common infections within the local community, and they result in higher morbidity and health care costs. While risk factors for skin and soft tissue infections have been previously evaluated, risk factors associated with secondary bloodstream infections (BSI) has not been investigated, especially in an intercity patient population with limited health care resources. In this case control investigation, 392 patients consisting of 196 cases (ABSSSI + BSI) and 196 controls (ABSSSI) were investigated to determine risk for BSI. Both sociodemographic and underlying conditions were evaluated. According to bivariate analysis of cases and controls, individuals with ABSSSI + BSI were significantly older (p < 0.001), more often male (p = 0.008), and had a higher percentage of abnormal symptoms, such as elevated temperature, white blood cell count, and acute renal failure on hospital admission (p < 0.001). Individuals with ABSSSI + BSI also had a higher percentage of chronic renal failure (p = 0.002), diabetes (p = 0.005), congestive heart failure (p = 0.012), intravenous drug use (p =0.012), and a history of prior hospitalization (p < 0.001). Several of these factors remained statistically significant by logistic regression analysis, such as male gender aOR of 1.85, 95% CI 1.11-3.66; acute renal failure aOR 2.08, 95% CI 1.18-3.67; intravenous drug use aOR 4.38, 2.22-8.62; and prior hospitalization aOR 2.41, 95% CI 1.24-4.93. This study contributes to positive social change by identifying patient characteristics that are associated with ABSSSI-related BSI, thus providing health care providers the ability to improve patient outcomes in this underserved patient population.

Central line-associated bloodstream infection (CLABSI) at the local healthcare setting exceeded the benchmark of 0 CLABSI. The Infection Prevention and Control (IPC) department determined that a role as CLABSI nurse champion would address the problem; however, no comprehensive education on CLABSI prevention and maintenance was available at the site. The purpose of this project was to develop a CLABSI prevention and maintenance education module using Knowles's adult learning theory and the chain of infection model. The practice-focused question asked whether a CLABSI educational module would provide the necessary information to educate nurse champions on CLABSI prevention and maintenance. The education module was presented to 9 local experts, composed of the Infection Prevention and Control (IPC) director, doctor of medicine, microbiologist, biomedical technologists, IPC nurses, and 2 staff nurses, who evaluated the CLABSI education module. An 11-question Likert-scale questionnaire that included an option for recommendations for improvement was used by the expert panel to evaluate the module. Of the 11 questions, only 3 were scored as strongly agree or agree, indicating a need to modify the module to raise the education level of the content and to include the clinical standards, objectives, and dressing-change procedures. After modifications, the education module was scored again, and 100% met the criteria and the recommendations of the expert panel. The project has the potential to promote positive social change by increasing the knowledge of the CLABSI nurse champions and by reducing the risk of CLABSI at the site.

Background: Catheter-associated bloodstream infections have been extensively studied in Intensive Care Unit Patients. However, less is known about the effect these infections have on non-ICU patients. This study attempted to elucidate the nature of the problem effecting non-ICU patients through descriptive analysis. Methods: Data were collected for all non-ICU patients with Staphylococcus aureus (S. aureus) infections at Grady Memorial Hospital in 2006. Demographic and hospitalization information was collected. The hospital epidemiologist responsible for surveillance of infection control programs determined outcomes attributable to the S. aureus infections. Data were entered into an Excel spreadsheet and then imported into EpiInfo 2007. Results: There were 91 S. aureus bloodstream infections documented, 38 infections in non-ICU patients and 52 infections in ICU patients. The descriptive information we accumulated offered potentially important different points between patients with MSSA and MRSA. We found more MRSA infection than MSSA infection in both the non-ICU and ICU patients. Additionally, in both groups those with MRSA infection had a length of stay at least twice as long as patients with MSSA, longer time from admission to positive blood culture, and longer time from positive blood culture to discharge. The most common type of morbidity found was sepsis, which was also the most common morbidity found in those who died. Conclusions: Our hypothesis that non-ICU patients would have increased morbidity and mortality directly attributable to the CA-BSI with S. aureus was proven to be false. Although still an issue, the morbidity and mortality was not as different as we thought it would be. While our hypothesis was proven false, this research provides information that would be well served through further studies.

Made available in DSpace on 2015-07-22T20:49:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-24 / Introdução: Apesar dos inúmeros avanços no entendimento da fisiopatologia das infecções da corrente sanguínea (ICS), a má evolução clínica e a manutenção da elevada mortalidade persistem nos pacientes com esta síndrome. O uso de terapêutica empírica de largo espectro, em virtude do desconhecimento da evolução e das características clínicas e microbiológicas dessas infecções em nossos hospitais agravam o surgimento da resistência microbiana e aumentam os custos relacionados sem, na maioria das vezes, diminuírem as taxas de morbidade e mortalidade dos pacientes acometidos pela doença. Objetivos: Observar a evolução clínica, os fatores predisponentes e a mortalidade atribuída em pacientes com hemoculturas positivas, durante 30 dias, em um hospital terciário, na cidade de Maceió. Metodologia: Foram incluídos no estudo 143 pacientes, admitidos no hospital sede da pesquisa, no período de outubro de 2005 a dezembro de 2006, que apresentaram pelo menos uma hemocultura positiva. Todas as variáveis foram aferidas sistematicamente no protocolo do estudo, até o trigésimo dia de evolução. Para se verificar a associação entre as variáveis qualitativas foi utilizado o teste de Qui-quadrado (SIEGEL). O nível de significância foi de 5%. O pacote estatístico utilizado foi o SPSS 15.0 for Windows. Resultados: Até o trigésimo dia de acompanhamento, 30,1% dos pacientes apresentaram apenas bacteremia e 69,9% evoluíram para sepse. Destes, 20,3% desenvolveram sepse grave e 10,5% evoluíram para choque séptico. A Taxa global de mortalidade no Hospital, durante o período da pesquisa foi de 3,7%, enquanto a mortalidade atribuída a esta patologia foi de 37,8%. Entre os pacientes que apresentaram quadro de bacteremia, sem repercussão clínica, sepse, sepse grave e choque séptico, estas taxas foram respectivamente 9,3%, 50%, 65,5% e 84,6% no trigésimo dia, após o diagnóstico. Os focos prevalentes nesta amostra foram secundários aos tratos: respiratório (32,2%), urinário (14%), e intra-abdominal (7,7%). 14% das ICS foram relacionadas ao cateter venosos central. Entre as especialidades que mais contribuíram para a casuística deste estudo estão a neurologia, cardiologia, clínica médica geral, oncologia, pediatria e neonatologia, correspondendo, respectivamente a 19,6%, 18,9%, 16,8%, 12,6%, 8,4% e 7,7%. A taxa de ocorrência de bacteremia/candidemia observada nas unidades de terapia intensiva (UTI) foi de 1,2%, contra 0,33% nas enfermarias. Nestas últimas, 55,12% evoluíram para sepse, enquanto na UTI este índice aumentou significativamente para 87,69% ( p<0,05). Entre as comorbidades, a diabetes melitus foi incidente em 26,6% dos casos, insuficiência renal crônica em 21,7%, neuropatia em 29,4% e a doença pulmonar obstrutiva crônica em 11,2%. Os principais agentes etiológicos isolados foram: Staphylococcus coagulase negativo (25,9%), Staphylococcus aureus (21%), Klebsiella pneumoniae (14%), Escherichia coli (9,1%) e Candida Spp. (8.4%). O principal microrganismo isolado nas hemoculturas dos pacientes que evoluíram para o óbito foi o S. aureus, presente em 24,1% dos casos. Observamos que 14% dos casos foram ICS de origem nosocomial. Conclusão: Os resultados apresentados condizem com os dados publicados na literatura, em relação à incidência, à evolução e a mortalidade atribuída aos distintos quadros das ICS e corroboram com a necessidade do estabelecimento das características desta doença, que poderão nortear as Instituições na adoção de medidas preventivas e terapêuticas eficazes. / Introduction: Despite the countless breakthroughs regarding the understanding of the pathophysiology of bloodstream infections (BSIs), poor response and persistently high mortality rates are the norm for these patients. In view of the poor knowledge as to the pathological outcome and clinical and microbiological features of these infections within our hospitals, the use of empirical broad-spectrum therapeutics contributes to the emergence of anti-microbial resistance and to higher related costs, without a concomitant reduction in morbidity and mortality rates for these patients. Objectives: Study the clinical outcome, the predisposing factors, and the mortality rate in patients with positive hemoculture during a 30-day period in a tertiary hospital in the city of Maceió. Methodology: A total of 143 patients referred to the hospital between October 2005 and December 2006 took part in the study. They all had at least one positive hemoculture result. All variables were systematically assessed for the study protocol during a 30-day interval. The Chi-square test (SIEGEL) was employed when verifying the association between the qualitative variables. Significance level was at 5%. The statistical analysis software used was the SPSS 15.0 for Windows. Results: At the end of 30 days, 30.1% of the patients had been diagnosed as having only bacteremia and 69.9% had developed sepsis. Out of this latter group, 20.3% went on to severe sepsis and 10.5% suffered from septic shock. Throughout the study, the overall mortality rate for the Hospital was 3.7%, whilst the like rate attributed to this malady was at 37.8%. Mortality rates for patients who had been diagnosed as having bacteremia with no clinical repercussions, with sepsis, severe septis, and septic shock, were, respectively, 9.3%, 50%, 65.5% and 84.6% thirty days after diagnosis. Secondary foci of infection were the most prevalent and were found in the respiratory (32.2%), urinary (14%), and intra-abdominal (7.7%) tracts. Fourteen percent of BSIs were related to the central venous catheter. The medical specialties accounting for most of the cases in this study were neurology, cardiology, general clinical practice, oncology, pediatrics, and neonatology. Their respective figures were 19.6%, 18.9%, 16.8%, 12.6%, 8.4%, and 7.7%. The bacteremia rate in intensive care units (ICUs) was 1.2%, as opposed to 0.33% in wards. Out of these latter cases, 55.12% of them turned into sepsis, while at the ICU this figure rose significantly to 87.69% ( p<0,05). Diabetes mellitus in 26.6% of the patients, chronic renal failure in 21.7%, neuropathy in 29.4%, and chronic obstructive pulmonary disease in 11.2% were the most prevalent comorbidities. Most commonly isolated etiological agents were: coagulase-negative staphylococcus (25.9%), Staphylococcus aureus (21%), Klebsiella pneumoniae (14%), Escherichia coli (9.1%), and Candida Spp. (8.4%). S. aureus was the isolated pathogen in 24.1% of fatal cases. Nosocomial BSIs accounted for 14% of the cases. Conclusion: With regard to prevalence, progression, and mortality attributed to distinct BSI cases, the results herein presented are in compliance with data published elsewhere. In addition, they lend support to the need for setting down the features that clearly define this disease, which in turn will lead to more effective treatment and greater preventive measures. / TEDE

Made available in DSpace on 2014-09-24T12:58:57Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Tese Liliane Miyuki Seki.pdf: 11573378 bytes, checksum: 779d1d4b49bfc191eafe332410d9730b (MD5) Previous issue date: 2012 / Enterobactérias produtoras de p-Iactamases de espectro estendido (ESBL) e Klebsiella pneumoniae carbapenemase (KPC) são reconhecidas mundialmente como importantes problemasde resistência bacteriana nos hospitais. Neste estudo, foi avaliada a prevalência dos genes codificadores de ESBL, bem como a epidemiologia molecular em isolados de hemocultura,em enterobactérias coletadas entre Setembro de 2007 a Setembro de 2008, em cincohospitais localizados no Estado do Rio de Janeiro, Brasil. Das 293 amostras coletadas, 121 foram caracterizadas fenotipicamente como produtores de ESBL sendo a maior prevalência de Klebsiella pneumoniae 63 (52,1%), Enterobacter cloacae 16 (13,2%), Escherichia coli 14 (11,6%), Proteus mtrabtlis 11 (9,1%), Serra tia marcescens 10 (8.3%), Morganella morganii 2 (1.7%), Enterobacter aerogenes 1 (0,8%), Klebsiella oxytoca 1 (0,8%), Providencia stuartii 1 (0,8%), Citrobacter freundii 1 (0,8%), Serratia rubidaea 1 (0,8%). Entre as produtoras de ESBL, 11 amostras de K. pneumoniae e 9 amostras de E cloacae mostraram resistência ou redução de susceptibilidade a pelo menos um dos carbapenemas. A detecção por PCR dos genes de p-Iactamase mostraram que 87,6% produziramblacTX_M, 65,3% blaTEM, 64,5% blaSHVe 9,1% blaxsc- O gene do grupo CTX-M-l foi predominante na maioria das espécies de enterobactérias, exceto para o P. mirabilis, onde 91% das amostras eram do gene do grupo CTX-M-2. Das amostras pertencentes ao grupo CTX-M-l, 88% das K. pneumoniae e 100% das Ecoli foram determinadas como CTX-M-15. A análise do polimorfismo genético, por PFGE, demonstrou a disseminação do gene CTX-M-15 em 10 genótipos para as amostras de K. pneumoniae e de 3 genótipos para Eco/i em diversos hospitais no Rio de Janeiro. (AU)

Os conectores sem agulhas foram introduzidos para redução de incidência de acidentes pérfuro-cortantes nos profissionais da área da saúde e a literatura apresenta evidências irrefutáveis sobre este aspecto. No entanto, não há evidências conclusivas sobre as vantagens do conector sem agulha para o paciente, no que se referem aos índices de infecção de corrente sanguínea relacionada ao cateter venoso central. Este estudo tem como objetivo evidenciar o impacto do uso de conectores sem agulhas para sistema fechado de infusão na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central por meio de revisão sistemática, desenvolvida conforme as recomendações propostas pela Colaboração Cochrane. A estratégia de busca nas bases de dados eletrônicas utilizou os componentes do PICO: População (estudos com pacientes em uso de cateter venoso central, independente de idade, sexo, etnia e serviço de saúde vinculado); Intervenção (uso de conectores de sistema fechado sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Comparação (uso de oclusores, conectores de sistema fechado com ou sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Outcome-desfecho (infecção de corrente sanguínea, contaminação do canhão, contaminação microbiana, infecção de corrente sanguínea relacionada ao cateter). As bases eletrônicas investigadas foram: PubMEDLINE, OVID, EMBASE, LILACS, CINAHL. Também foram avaliadas as referências bibliográficas dos estudos incluídos. Os resultados estão apresentados em três etapas: caracterização do processo de seleção dos estudos encontrados na busca; caracterização dos estudos incluídos para a revisão sistemática (RS); avaliação de qualidade e força da evidência dos estudos incluídos segundo a Escala de Jadad e a Escala de avaliação de qualidade dos estudos na área de Controle e Prevenção de Infecção de Corrente Sanguínea Relacionada ao cateter Venoso Central. A amostra desta revisão sistemática constitui-se de 14 estudos, e quatro investigaram somente conectores sem agulhas. Foram encontrados 6 ensaios clínicos controlados randomizados, 4 coortes, 3 caso-controle e 1 resultado terapêutico. A infecção de corrente sanguínea relacionada ao cateter venoso central foi o desfecho de 9 estudos. Seis apresentaram diferenças a favor do conector valvulado; 04 a favor do conector puncionável com cânula; 01 a favor do conector puncionável com agulha; 01 a favor do conector valvulado com pressão positiva e 02 a favor do dispositivo usado antes da troca. A heterogeneidade dos estudos quanto aos desenhos de pesquisa, as características das populações e os fatores de riscos controlados e os resultados, não permitem a realização de meta-análise, contudo, é possível afirmar, com base nos quatro melhores estudos encontrados, que a implantação de conectores sem agulhas, quer valvulados ou com injetor pré-furado, com manutenção de sistema fechado de infusão, apresentam impacto positivo relacionado à menor contaminação do canhão do cateter ou na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central / Needleless connectors were introduced to reduce the incidence of needlestick injuries in health professionals and according to the literature their effectiveness is irrefutable. However, there is no conclusive evidence on the advantages of needleless connectors for patients with regard to bloodstream infection rates from the use of central venous catheters. The objective of this study was to determine the impact of the use of needleless connectors in closed infusion systems on the occurrence of bloodstream infections related to the use of central venous catheters by conducting a Cochrane systematic review. The strategy for searching electronic databases employed the components of the PICO model: Population (studies of patients using central venous catheters, regardless of age, sex, race and associated health service); Intervention (use of closed needleless connector systems, with and without valves, with and without positive pressure); Comparison (use of plugs, closed system connectors with and without needles, with and without valves, with and without positive pressure); Outcome (bloodstream infection, cannula contamination, microbial contamination, bloodstream infection related to catheter). The electronic databases investigated were: PubMEDLINE, OVID, EMBASE, LILACS and CINAHL. Bibliographical references of the studies included were also evaluated. The results are presented in three stages: characterization of selection process for studies found in the search; characterization of studies included in the systematic revision; evaluation of quality and strength of evidence for studies included according to the Jadad Scale and the scale of quality of studies in the control and prevention of bloodstream infections related to central venous catheters. The sample of this systematic review was made up of 14 studies of which 4 investigated only needleless connectors. We found 6 randomized control clinical trials, 4 cohort, 3 case-control and 1 therapeutic result. Bloodstream infection related to central venous catheters was the outcome for 9 studies. Six presented differences regarding the valved connector; 04 in favor of the puncturable connector with cannula; 01 in favor of the puncturable connector with needle; 01 in favor of the valved connector with positive pressure and 02 in favor of the device used before the change. The heterogeneous nature of the studies with regard to design, population characteristics and controlled risk factors and results prevented a meta-analysis. However, it is possible to state, based on the four best studies found, that the introduction of needleless connectors, whether valved or puncturable with cannula, coupled with a closed infusion system, presented a positive impact on lowering contamination of catheter cannulae and on the occurrence of bloodstream infection related to central venous catheters

Patients with cancer who receive bone marrow transplants (BMT) are at increased risk for central line-associated blood stream infections (CLABSI), a serious complication leading to increased costs, length of stay, and even death. Recognition of an increased CLABSI rate at one BMT unit in the southwestern United States prompted development of an evidence-based staff development education program to improve nurses’ knowledge of central line maintenance and CLABSI prevention practices. Guided by Lewin change theory, the program was developed based on a nurse-led analysis and synthesis of the evidence, and a formative evaluation of the educational program conducted by a 3-member expert panel made up of the BMT director, a BMT clinical nurse specialist and vascular access team member. The review confirmed the lack of standardized evidence-based guidelines for central venous catheter care, that any patient who has a central line is at risk for CLABSI, and BMT patients are at particular risk due to frequency of catheter manipulation. Findings reinforced the need for the recommendations to educate nurses in BMT settings on evidence-based central line practices, evaluate knowledge gained, and audit practice techniques post education. The social change implication of this DNP project will be the potential decrease in healthcare costs, length of stay, and mortality associated with central line infections when nursing staff are provided an educational program that aims to improve their knowledge and skills of evidence-based central line care and CLABSI prevention practices.

Contaminated blood cultures constitute diagnostic challenges and place a burden on healthcare services. An observational retrospective study was undertaken to evaluate the effect of routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, on blood culture contamination rates. The contamination rate of the entire facility was 2.6% before the procedural change, and this decreased significantly to 1.5% after the procedural change (P < 0.001) over the first 12 months of the intervention. Routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, was effective in reducing blood culture contamination rates.