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Clinical Practice Guidelines for Prevention of Nosocomial Infections Associated with the Use of Medical Devices

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About 3M Health Care
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  • 1. Clinical Practice Guidelines for Prevention of Nosocomial Infections A I f ti Associated with th U of M di l D i i t d ith the Use f Medical DevicesCarlos Arturo Alvarez, Jorge Alberto Cortes, Carlos Hernando Gomez, Julian Alfredo Fernandez, Monica Patricia Sossa, Ad i M i P i i S Adriana Padilla P dill Colombian Society of Intravascular Therapy (ACOTEIN) Colombian Society of Infectology (ACIN) Colombian Society of Hospital Pharmacists June – September, 2010
  • 2. Issue: Strategies for the Prevention of CRBSI inColombia Background I fC l bi – B k d Information ti• Healthcare-associated infections (HAI) are an important public health problem and an indicator of quality of healthcare management. Adaptation and implementation of clinical guidelines for HAI prevention are strategies that can improve the safety of patient care and should be a priority in the institution.• In several Colombian hospitals a study on adverse effects (IBEAS) was hospitals, performed. This study shown that 37.2% of the reported adverse effects were related to HAI.• Alvarez et al conducted a 3 year prospective surveillance study of et. al., healthcare-associated infections in 9 Colombian hospitals by using CDC definitions for device-associated infections. They found a catheter-related bloodstream infection of 11.3 episodes per 1000 device-days and a crude 11 3 device days attributable mortality of 18.5%
  • 3. The Intervention• Evidence-based clinical practice guidelines for the prevention of healthcare-associated iinfections related to iinvasive medicall d i h lh i d f i l d i di devices were prepared by a multidisciplinary panel of experts: Infectious Diseases Physicians Critical Care Physicians Infection Control Physicians, Physicians, Nurses and Pharmacist.• They did a systematic review of the literature and evidence-base evidence base information available in international, regional and local guidelines as well as best standard of practices information. p
  • 4. The Results• All the recommendations described in this guideline are evidence-based, but they were adapted to the Colombian h lth C l bi healthcare setting and reality tti d lit• These guidelines are intended to be applied by healthcare workers with the aim to establish strategies to prevent HAI related to invasive medical devices• The Practical Clinical Guidelines (CPG in Spanish) are the result of the joint effort of several different scientific healthcare professional societies from Colombia: • Society of Infectology (ACIN) • Society of Critical Medicine and Critical Care (ASOCRIT) • Society f Hospital Ph S i t of H it l Pharmacist i t • Society of Intravascular Therapy (ACOTEIN)
  • 5. Adaptation Process of International Guidelines • Search and systematic review of international literature available was done: 32 published g p guidelines from 1994 to 2010. • The main criteria for the selection of guidelines were consistency, acceptability and applicability. Six guidelines were selected. • The evaluation of selected guidelines was achieved using the AGREE (Appraisal of Guidelines of Research & Evaluation) Instrument. Three guidelines were selected. g • National evidence -based guidelines for preventing healthcare associated infections in NHS hospitals in England • Prevention of health care associated infection in primary and community care • CDC Guidelines for the prevention of intravascular catheter related infections. • External evaluation, feedback and consolidation of the final document.
  • 6. Adapted Recommendations(Level of Evidence and Strength of Recommendation)• Healthcare workers and patient education and training about vascular access devices (V01 – V04)• Positional Strategies (V05 – V08)• Catheter insertion site care (V09 – V36)• Insertion site and CVC type selection (V37 – V43)• Replacement strategies for CVC (V44 – V48)• Integrated Prevention (V49 – V51)
  • 7. Your Best Advice• Multidisciplinary team work approach: one problem, diff bl different perspectives, b t one goall t ti but• Look for opportunities to influence a more specialized clinical practice inside hospitals and clinical setting because the impact on patient safety and health economic would be greater
  • 8. Sustaining Change g g• The guidelines and process to build the document require a permanent review and update i t i d d t• Communication and accessibility of these guidelines to h it l t ff i iti for t hospitals staff is criticall f iimplementation and l t ti d healthcare professional behavior change• Real time exercises for the alignment of these guidelines with the local facilty protocols• Measure changes in institutions to verify the improvements