Objective: The aim of this study was to conduct a narrative synthesis of randomized trials to evaluate the evidence on the effectiveness of antibiotics and antiseptics in preventing central line-associated bloodstream infection (CLABSI) in intensive care unit patients. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, and Scopus databases were searched for randomized controlled trials published from 2012 to March 2024. The methodological quality of the included studies was independently evaluated by 2 reviewers using the Critical Appraisal Skills Programme Spanish [Español] appraisal tool. Following data extraction, a narrative synthesis was performed to integrate and interpret the findings across studies. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO). Results: Nineteen randomized trials were appraised using the Critical Appraisal Skills Programme Spanish [Español] tool, of which 13 high-quality studies (score ≥6) were included in the review. These trials assessed antiseptic (alcohol, chlorhexidine), antibiotic (rifampin), or combined interventions versus standard care. Antiseptic and antibiotic-impregnated catheters and alcohol caps were associated with reduced CLABSI rates, hospital stay, and costs, while evidence for alcohol lock therapy was inconclusive. Conclusion: This review supports the use of antiseptic and antibiotic-coated catheters as promising measures to prevent CLABSI in critically ill patients. However, caution is warranted with alcohol lock therapy due to limited and conflicting evidence.
Objective: This study aimed to evaluate patients’ knowledge of using the Visual Infusion Phlebitis (VIP) score for self-monitoring of peripheral intravenous catheters (PIVCs) during hospitalization. Methods: A descriptive comparative pilot study was conducted on 64 inpatients aged ≥18 years by using a structured Patient Knowledge Evaluation Questionnaire (PKEQ) on days 1, 2, and 3 of hospitalization. Patients received education on using the VIP score after admission. Patient knowledge levels, phlebitis scores, and major adverse events were compared between younger participants aged ≥18 years to <70 years and older participants aged >70 years. Results: Results were statistically significant for patient knowledge of using the VIP score on day 1 ( P < .015) and day 2 ( P < .037) after PIVC insertion but not for day 3. Patients’ accuracy of scoring was comparable with nurses’ scores. Major in-hospital adverse events were not statistically different. Patients of all ages ≥18 years to >70 years applied their knowledge of the VIP score for accurate assessment and monitoring of their PIVCs for visual signs of phlebitis. Conclusion: These findings could guide innovative clinical practice developments in safe PIVC care by promoting patient education on using the VIP score for early visual detection of PIVC-related complications.
OBJECTIVE:This study was the first to assess inpatient use of ClearGuardTM HD antimicrobial barrier caps for the reduction of hemodialysis catheter-related central line-associated bloodstream infections (CLABSI) compared to the use of Tego™️ needlefree connectors with Curos™️ caps. METHODS:Retrospective observational data were used to evaluate the effect of ClearGuard on the CLABSI rate and standardized infection ratio (SIR) compared to the baseline rate and ratio. Financial analysis was conducted to measure return on investment. RESULTS:Compared to the baseline period, data from the implementation period showed a long-term CLABSI reduction from 1.91/month/site (95% CI: [0.91-4.00]) to 0.71/month/site (95% CI: [0.33-1.53]), a 63% reduction (95% CI: [46%-74%]) in CLABSIs (P < .00005). The overall SIR was reduced by 57%, from a baseline of 0.721 to 0.310. The annual cost savings were estimated at $1.6 million. CONCLUSION:The findings from the ClearGuard study and ongoing use across hospitals indicate a clinically significant reduction in hemodialysis catheter-related CLABSI events and associated costs.
