The Affordable Care Act (ACA), more commonly known as Obamacare, is 906 pages long. But amidst all that detail are a few driving goals. One of those is something few would argue with: higher quality healthcare at lower cost. That’s also the focus of a new white paper on vascular access.
It’s no wonder the ACA’s authors made that a priority. The U.S. lags behind other industrialized countries on both sides of the quality/cost equation. We have the most expensive healthcare, by far, among industrialized nations, according to both the Organization for Economic Co-operation and Development (OECD) and the healthcare-focused Commonwealth Fund. The U.S. also ranks worse than many of these nations on some measures of quality, including safety.
Having worked previously for the Association for Vascular Access (AVA), last year we began supporting the efforts of AVA’s research and education arm, the Wise Foundation.
AVA and the foundation ended the year on a high note, with the announcement of a major grant from AVA to the foundation. The $50,000 grant, given in honor of AVA’s membership, underlines AVA’s support for the foundation’s mission. The grant also strengthens the foundation’s outreach to other major funders.
For years, efforts to reduce central-line associated bloodstream infection (CLABSI) rates have focused on relatively complex initiatives – including “bundles” of evidence-based practices and technologies that together create multi-layered protection against infections. Now, the early results of a prospective, peer-reviewed clinical trial suggest that the use of a simple but ingeniously designed device can contribute to improved disinfection and allow for reduced CLABSIs.
That device – SwabCap® by Excelsior Medical – is also known as a disinfection cap. SwabCap supplements manual disinfection of IV connectors, long thought to be a weak point in CLABSI prevention because the method is subject to variation and noncompliance. The study results were recently reported at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).
Early results of the prospective, peer-reviewed clinical trial demonstrated that SwabCap® improved disinfection and allowed for reduced central-line associated bloodstream infection rates of more than 79%. Those improvements were seen in the four-hospital NorthShore University HealthSystem (Evanston, Ill.) after SwabCap was implemented for use on all central lines.
Notably, the gains were made even though the hospitals already had a low rate CLABSI rate of 1.95 per 1,000 catheter days before SwabCap was tried.
NorthShore also studied the device’s effectiveness a second way: it compared the density of colony-forming units (CFUs) of bacteria in blood samples when SwabCap was used to CFUs in samples when it wasn’t. During the SwabCap phase of the research, contaminated samples were 75% less dense with bacteria.
The new data is the most extensive ever gathered on SwabCap. The device is in use at multiple institutions, sometimes allowing for a drop in infection rates that is even more dramatic than at NorthShore. More at http://www.swabcap.com.
We often think of young people as rebels and their elders as better at following rules. But the opposite is true in American hospitals, a new study says – at least when it comes to disinfecting IV connectors.
Recent graduates of nursing school were more likely “to consistently use optimal disinfection techniques” than were more experienced nurses, according the study, in the May-June issue of the Journal of Infusion Nursing,.
The research examined whether younger or more experienced nurses adhered more closely to the “scrub-the-hub” manual method for disinfecting connectors. The method requires nurses to scrub the connector hubs with alcohol for up to 10-15 seconds and then wait up an additional 30 seconds for the alcohol to dry before accessing the line.
This protocol is widely recommended by infection control experts, but it must be performed meticulously to have any chance of being effective. The method’s several steps mean that variation is common, and busy nurses are known to sometimes skip disinfection altogether. The consequences of variation or noncompliance are great because incomplete disinfection increases the risk for sometimes deadly central line-associated bloodstream infections (CLABSIs).
The study found that nurses just out of school were more likely to perform the protocol exactly as it was taught – a good thing. The more experienced nurses, conversely, rated higher than younger nurses in such qualities as autonomy and “self-efficacy” (essentially, belief in one’s own competence). One can assume from this that more experienced nurses felt more free to stray from the protocol – not a great idea in this case and one that put patients in danger.
The findings may point toward one reason hospitals should be using a disinfection cap such as SwabCap® to supplement manual disinfection. SwabCap, from our client Excelsior Medical, is ingeniously designed to eliminate variation and noncompliance.
By prolonging the hub’s contact with alcohol, it may also increase the bacteria kill over manual methods, especially when compliance with the manual method is not optimal.
Considering what’s at stake, it seems to us that using the cap is a no-brainer – even if a nurse just graduated magna cum laude.