Patients with central venous catheters (CVC) are at increased risk of having a Central Line-associated Bloodstream Infection (CLABSI). CLABSI increase hospital length of stay, costs, and patient ...morbidity. Through the use of nationally accepted cares, the CLABSI prevention bundle, we strive for zero CLABSI. Part of the bundle is that patients with a CVC receive a chlorhexidine gluconate (CHG) treatment daily, have a CHG impregnated disk placed at the insertion site, and receive CHG based skin antisepsis prior to procedures. In the CLABSI root cause analysis for 2018, allergy to CHG was identified as a contributing factor. Often these are potentially contact dermatitis and are parent reported with no standardized method to re-test or consistent guidance on what skin antisepsis to use in place of CHG. How can we reintroduce CHG products and standardize skin antisepsis for CVC care if the patient has a potential CHG allergy?
For 9/1/2017 through 8/31/2018 patients with a documented CHG allergy were identified. A multidisciplinary workgroup was assembled. A literature review, chart reviews, and knowledge sharing with similar institutions were completed. Literature was limited with the majority of reports on anaphylaxis reaction (vs dermatitis) and provided no evidence-based standard. In a review of ∼100 patients, only 20 had a documented allergy.
Based upon the findings an algorithm for CVC contact dermatitis was created and implemented. We attempted to standardize skin patch testing with various CVC products, published an algorithm of alternative CVC care for patients with a potential CHG allergy, and created a family education sheet on the highest used alternative, betadine.
A limited pilot of the algorithm showed 67% of the patients included had skin improvement when using the algorithm. A bloodstream infection while having dermatitis was identified in 78% of patients. In 2020 the number of CHG allergy patients decreased by 26%.
Abstract
Background
Hand hygiene reliability is a top priority in healthcare. Infection Prevention and Control (IPC) programs often rely on clinical personnel to audit hand hygiene performance. ...Interrater reliability among auditors is critical to ensuring data validity. We evaluated whether spaced education, which increases long-term knowledge retention, could be integrated into auditor competency assessment.
Methods
113 trained hand hygiene auditors were enrolled in a 13-month online spaced-education platform to assess their mastery of knowledge needed for the role. We delivered 46 unique questions (3 per week, with 2 weeks between repeat delivery of a question) followed by rationale; we retired questions after 3 correct answers. A 10-item survey consisting of 9 Likert-scale questions and one free-text comment was emailed to gauge participant satisfaction with the competency program. Frequencies and percentages were used to summarize Likert responses, and themes were elicited from comments.
Results
From November 2021 to December 2022, a total of 12,120 questions were attempted, and 32 of 113 auditors (28%) completed the competency. Auditors answered 70% of questions correctly on the first attempt and 83% on the final attempt. 30 of 113 auditors (27%) responded to the survey. The majority agreed the number and complexity of questions were appropriate (57% and 67%, respectively). 87% reported the platform easy to navigate, 63% reported the spaced-education model worked, and 77% agreed adequate time was provided for completion. 30% of respondents reported the individual competition as enjoyable. Time and effort required for completion was the most common theme identified among auditor comments; several respondents recommended fewer questions at a narrower spacing interval over a shorter time frame due to competing work demands; 5 individuals expressed a preference for an annual computer-based module.
Conclusion
A spaced education competency program improved hand hygiene auditor knowledge in the short term. Completion rate was low and participants expressed a desire for fewer questions over a shorter time frame. This study offers insight into ways to optimize spaced education as a potential tool for hand hygiene competency assessment.
Disclosures
Ana M. Vaughan-Malloy, MD, MPH, Asana: Stocks/Bonds|Aurora: Stocks/Bonds|Ayr Wellness: Stocks/Bonds|Bionano Genomics: Stocks/Bonds|Butterfly Network: Stocks/Bonds|Canopy Growth: Stocks/Bonds|Cresco Labs: Stocks/Bonds|CRISPR Therapeutics: Stocks/Bonds|Cronos Group: Stocks/Bonds|Curaleaf Holdings: Stocks/Bonds|Editas Medicine: Stocks/Bonds|Green Thumb Industries: Stocks/Bonds|High Tide: Stocks/Bonds|Iovance Biotherapeutics: Stocks/Bonds|Jushi Holdings: Stocks/Bonds|Moderna: Stocks/Bonds|Organigram Holdings: Stocks/Bonds|Pacific Biosciences of California: Stocks/Bonds|Personalis: Stocks/Bonds|Pfizer: Stocks/Bonds|SNDL Inc: Stocks/Bonds|Terrascend: Stocks/Bonds|Tilray Brands: Stocks/Bonds|Trulieve: Stocks/Bonds
•Quality improvement project was initiated at a large, academic freestanding children's hospital for inpatients with an indwelling urinary catheter.•An audit tool based on Kamishibai, a Japanese form ...of storytelling, was developed based on CDC CAUTI prevention recommendations.•Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses.
We instituted Kamishibai (K-card rounding) with the goals of improving indwelling urinary catheter maintenance bundle reliability and decreasing catheter-associated urinary tract infection (CAUTI) rates.
In a free-standing children's hospital, we undertook a hospital-wide quality improvement project from January 2019 to June 2021 after developing a K-card based on our urinary catheter maintenance bundle. Auditors used K-cards to ask standardized questions during weekly rounds. Bundle reliability and CAUTI rates were analyzed prospectively.
During the study period, 826 K-card audits were performed for 657 unique patients. While overall maintenance bundle reliability remained stable at 84%, there was a statistically significant improvement in reliability to the bundle element “medical discussion of need for the urinary catheter” from 88% to 94% (P = .01). The hospital-wide CAUTI rate significantly decreased (incidence rate ratio, 0.38; 95% CI, 0.15-0.93; P = .04).
Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability and real-time feedback to nurses. Maintenance bundle reliability remained stable after implementation, accompanied by a significant decrease in the CAUTI rate.
Implementation of hospital-wide urinary catheter K-card rounding was associated with reduction in CAUTI rates. The project demonstrated likelihood of reproducibility with support of a multidisciplinary team.
Malignant hyperthermia (MH) is a potentially fatal autosomal dominant disorder of skeletal muscle and is triggered in susceptible people by all commonly used inhalational anaesthetics. To date, the ...ryanodine receptor gene (RYR1) has been shown to be mutated in a small number of malignant hyperthermia susceptible (MHS) cases. To determine if a common RYR1 mutation exists that might account for a significant number of MHS cases, we have investigated the RYR1 gene in unrelated patients for the presence of new mutations by the single-stranded conformation polymorphism method and have identified a novel Gly341Arg mutation which accounts for approximately 10% of Caucasian MHS cases. The implications of this common mutation in MHS diagnosis and heterogeneity studies are discussed.
