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      Improving Aseptic Technique During the Treatment of Pediatric Septic Shock : A Comparison of 2 Rapid Fluid Delivery Methods

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          Abstract

          Rapid fluid resuscitation is used to treat pediatric septic shock. However, achieving fluid delivery goals while maintaining aseptic technique can be challenging. Two methods of fluid resuscitation—the commonly used push-pull technique (PPT) and a new fluid infusion technique using the LifeFlow device (410 Medical, Inc; Durham, NC)—were compared in a simulated patient model. PPT was associated with multiple aseptic technique violations related to contamination of the syringe barrel. This study confirms the risk of PPT-associated syringe contamination and suggests that this risk could be mitigated with the use of a protected syringe system, such as LifeFlow.

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          Most cited references 18

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          Multistate point-prevalence survey of health care-associated infections.

          Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. We defined health care-associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care-associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care-associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011. Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care-associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care-associated infections). Device-associated infections (i.e., central-catheter-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care-associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011. Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care-associated infections.
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            The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.

            To better understand the absolute and relative risks of bloodstream Infection (BSI) associated with the various types of intravascular devices (IVDs), we analyzed 200 published studies of adults In which every device in the study population was prospectively evaluated for evidence of associated infection and microbiologically based criteria were used to define IVD-related BSI. English-language reports of prospective studies of adults published between January 1, 1966, and July 1, 2005, were identified by MEDLINE search using the following general search strategy: bacteremla [Medical Subject Heading, MeSH] OR septicemia [MeSH] OR bloodstream Infection AND the specific type of intravascular device (e.g., central venous port). Mean rates of IVD-related BSI were calculated from pooled data for each type of device and expressed as BSIs per 100 IVDs (%) and per 1000 IVD days. Point incidence rates of IVD-related BSI were lowest with peripheral Intravenous catheters (0.1%, 0.5 per 1000 IVD-days) and midline catheters (0.4%, 0.2 per 1000 catheter-days). Far higher rates were seen with short-term noncuffed and nonmedicated central venous catheters (CVCs) (4.4%, 2.7 per 1000 catheter-days). Arterial catheters used for hemodynamic monitoring (0.8%, 1.7 per 1000 catheter-days) and peripherally inserted central catheters used in hospitalized patients (2.4%, 2.1 per 1000 catheter-days) posed risks approaching those seen with short-term conventional CVCs used in the Intensive care unit. Surgically implanted long-term central venous devices--cuffed and tunneled catheters (22.5%, 1.6 per 1000 IVD-days) and central venous ports (3.6%, 0.1 per 1000 IVD-days)--appear to have high rates of Infection when risk Is expressed as BSIs per 100 IVDs but actually pose much lower risk when rates are expressed per 1000 IVD-days. The use of cuffed and tunneled dual lumen CVCs rather than noncuffed, nontunneled catheters for temporary hemodlalysis and novel preventive technologies, such as CVCs with anti-infective surfaces, was associated with considerably lower rates of catheter-related BSI. Expressing risk of IVD-related BSI per 1000 IVD-days rather than BSIs per 100 IVDs allows for more meaningful estimates of risk. These data, based on prospective studies In which every IVD in the study cohort was analyzed for evidence of infection by microbiologically based criteria, show that all types of IVDs pose a risk of IVD-related BSI and can be used for benchmarking rates of infection caused by the various types of IVDs In use at the present time. Since almost all the national effort and progress to date to reduce the risk of IVD-related Infection have focused on short-term noncuffed CVCs used in Intensive care units, Infection control programs must now strive to consistently apply essential control measures and preventive technologies with all types of IVDs.
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              Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections.

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                Author and article information

                Affiliations
                Departments of Internal Medicine and Pediatrics, University of North Carolina (UNC) Health Care, Chapel Hill, North Carolina (Dr Spangler); 410 Medical, Inc, Durham, North Carolina (Dr Piehl, Mr Lane, and Mr Robertson); University of North Carolina School of Medicine, Department of Pediatrics, Chapel Hill, North Carolina (Dr Piehl); and WakeMed Health and Hospitals, Raleigh, North Carolina (Dr Piehl).
                Hillary Spangler, MD, is a resident physician in the Departments of Internal Medicine and Pediatrics at University of North Carolina (UNC) Health Care. She received her medical training at UNC Chapel Hill. A pediatric sepsis survivor, Dr Spangler's clinical and research interests involve sepsis and quality improvement. She is also an active participant in UNC's Code Sepsis Initiative.
                Mark Piehl, MD, MPH, is a pediatric intensivist at WakeMed in Raleigh, North Carolina, and is a clinical associate professor in the Department of Pediatrics at the UNC School of Medicine. He received his MD and MPH degrees from UNC and is now chief medical officer of 410 Medical, Inc.
                Andrew Lane, MS, BS, is a mechanical engineer at 410 Medical, Inc. He has done research in ergonomics and human factors of medical devices, critical care, and robotics. He obtained a BS in biomedical engineering from UNC Chapel Hill and an MS in mechanical engineering from North Carolina State University.
                Galen Robertson, MSME, BSME, is a mechanical engineer and the chief operating officer at 410 Medical, Inc. He has been involved in research involving ergonomics and human factors of medical devices in critical care, general surgery, and robotics. He earned his BSME and MSME degrees from Georgia Institute of Technology in Atlanta.
                Author notes
                Corresponding Author: Hillary Spangler, MD, University of North Carolina Hospitals, Internal Medicine-Pediatrics, 118 Knox Way, Chapel Hill, NC 27517 ( hbspangler8@ 123456gmail.com ).
                Journal
                J Infus Nurs
                J Infus Nurs
                JINFN
                Journal of Infusion Nursing
                Wolters Kluwer Health, Inc.
                1533-1458
                1539-0667
                January 2019
                11 January 2019
                : 42
                : 1
                : 23-28
                30589717 6314506 10.1097/NAN.0000000000000307 jinfn4201p23
                © 2019 The Authors. Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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