Nursing central line service prevents catheter related infections.

Bacteraemia associated with central venous catheter (CVC) usage in acutely ill patients has been shown to increase mortality and morbidity. Acutely ill patients are at a greater risk of infection, underscoring the importance of effective care models.

The reporting of the prevalence of catheter related blood stream infections varies widely in the literature with on average five infections per 1,000 catheter days reported. In Australia it is reported that over 3,500 CVC infections occur annually, many of which are preventable. These infections are associated with an annual mortality rate of 12% and an increase in the average length of stay of greater than seven days. Every year approximately 34 patients die in intensive care units (ICUs) in Australia of CVC associated infections and the cost is estimated to be as high as $8.2 million (Victorian National Nosocomial Infection Surveillance System (VICNISS, 2005).

Strategies to decrease CVC infections include adhering to strict hand washing protocols, aseptic technique on insertion and on accessing the catheter and use of chlorhexidine skin antiseptics. The choice of catheter site placement and regular surveillance of inserted central lines are also important factors in optimal catheter outcomes. (NSW Department of Health Central Line Associated Bacteraemia in Intensive Care Units project).

Having a dedicated central venous access service can also assist in the reduction of CVC infections through increased specialisation and implementation of best practice recommendations. The Central Venous Access Service (CVAS) based in the intensive care unit at Liverpool Hospital, NSW, is coordinated by two advanced practice nurses whose role it is to not only insert CVCs throughout the hospital but also actively engage in the setting and monitoring of clinical practice standards. In this model of care, increased access to expert clinical assessment and specialist care means that vascular access is tailored to specific patient needs and as a consequence patient outcomes are improved.

The CVAS plays an important education and training role through performing routine inservice sessions and educational programs for nursing and medical staff on CVC management and handling. One of the most important education roles the service undertakes is the training and accreditation of medical staff in central venous access: yes, nurses teaching doctors[ In these sessions apart from the emphasis on technical skills, significant emphasis is put on the use of aseptic principles even in the setting of resuscitation. The CVAS is an example of how a nurse coordinated model of care using best practice standards can improve patient outcomes through reducing infection.

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REFERENCES

NSW Department of Health, Clinical Excellence Commission. Central Line Associated Bacteraemia in Intensive Care Units project. Available from: http://www.cec.health.nsw.gov.au/ (accessed May 2008).

Victorian National Nosocomial Infection Surveillance System (VICNISS) Hospital Acquired Infection Project, Year 3 report, June 2005. Available from: http://www.vicniss.org.au/resources/ VICNISSAnnualReport0705.pdf (accessed May 2008).

EVAN ALEXANDROU IS A CLINICAL NURSE SPECIALIST FOR CENTRAL VENOUS ACCESS AND INTENSIVE CARE AT LIVERPOOL HOSPITAL. TIM SPENCER IS THE CLINICAL NURSE CONSULTANT FOR CENTRAL VENOUS ACCESS AND TPN AT LIVERPOOL HOSPITAL. PATRICIA DAVIDSON IS PROFESSOR OF CARDIOVASCULAR AND CHRONIC CARE AT CURTIN UNIVERSITY OF TECHNOLOGY.