A safe input

Intravascular catheters are a staple in the modern-day medical world. EHM talks to two industry experts on the potential challenges and emerging solutions facing catheter-related infections. VWith Mark Hunter from Baxter Healthcare and Kerry Edgar from Medegen Inc.

“It is important to understand that infusion therapy, including intravenous catheters and the care of catheters, is only a small part of the clinician's formal training, and a lot is on-the-job training”
-Mark Hunter

Preventing the transmission of infectious agents in healthcare settings has always been a key concern for healthcare practitioners. What are the key challenges for healthcare professionals and facilities alike in terms of implementing effective infection control?
Mark Hunter. The key challenges for healthcare professionals and facilities in implementing effective infection control are the increased resistance of today's microorganisms and the lack of knowledge related to their transmission. The super bugs of today are much more difficult to treat requiring stronger anti-infective medications and longer treatment, often requiring a central line catheter (another risk factor for infection). As far as education, we need to ensure that not only clinicians but patients, family members, and friends understand the seriousness of infections and the steps to prevent the spread. We need to hold each other accountable when we see key steps, such as hand washing or donning personal protective equipment for isolation ignored, which could potentially spread infectious agents.

Kerry Edgar. The challenges facilities face in implementing effective infection control are lack of administrative resources to implement and manage infection prevention programs, and a lack of financial resources to employ new technologies. Implementing an infection prevention program requires staff to manage and monitor the program, assuring adherence to the program guidelines, collection of data, and outcome measurement. Effective programs require buy in from all participating staff, along with evidenced based best practices and new product technologies. Consistent education and compliance monitoring on use of evidence based practices, such as hand hygiene and the IHI bundle, are required for success. Effective programs often require a change of culture at the hospital through use of a multi-department team approach.  Often times the patient to nurse ratio is very high, limiting the amount of time a HCW has to perform best practices, and this may result in sub-optimal practices. As manufacturers, we are developing better products to help enhance the performance of best practices and further educate clinicians on the need to perform these practices at the most optimal level.

Intravascular catheters are indispensable in modern-day medical practice, yet their use can put patients at risk of local and systemic infectious complications. What new solutions are emerging to help mitigate such risks?
KE. Many new interventions are being utilized to help facilities reduce catheter associated bloodstream infections. These interventions include devices designed to prevent migration of pathogens into the bloodstream from both extraluminal and intraluminal pathways. New technologies that assist in preventing intraluminal pathogen transmission feature antimicrobial protection, specifically catheters, needleless connectors, and lock solutions. In laboratory studies, antimicrobial additives in needleless connectors have been shown to greatly reduce the growth of pathogens associated with bloodstream infections.  The MaxGuard™ Advanced Luer Activated Device from Maximus has been shown to kill greater than 99.999 percent of the most common pathogens associated with catheter associated infections. Published clinical studies also support the use of antimicrobial catheters, which provide an additional layer of protection especially relevant to a facility's most immuno-compromised patient population. Antimicrobial protection does not negate the need for proper nursing practices; these new technologies must be accompanied by best clinical practices in order to realize a significant, sustained reduction in catheter associated bloodstream infection rates. 

MH. There are multiple antimicrobial technologies in the emerging market. These include central line catheters, skin prep, needleless IV access devices, as well as preps/cleaners, sutures, dressings, and lock solutions. Equally as important are new educational programs designed to improve utilization of vascular access devices with early vascular access assessment, and ensuring that the right catheter is placed and removed appropriately.

Is a purely technological/scientific response required? Or is it just as much about improving processes and raising awareness as to the issues involved? How have you been involved in terms of increased user education?
MH. Infusion therapy has become a part of day-to-day life within a hospital, whether it is for a diagnostic procedure or medication. It is important to understand that infusion therapy including intravenous catheters and the care of catheters is only a small part of the clinician's formal training and a lot is on the job training. This is where it becomes extremely important to have strong policies and procedures and educators to facilitate the training of new staff.

Advanced techniques and technology need to be utilized together to reduce the risk and help prevent catheter-related bloodstream infections (CR-BSIs). Clinicians have made great strides in the reduction of infections, but CR-BSIs still remain. Technology advances can aid clinicians in their quest by improving the techniques already in place. A great example is the use of silver in catheters and needleless IV access devices to further reduce the risk of contamination along with the use of the catheter insertion bundle. Healthcare and industry need to work together, combining their efforts to one day completely eliminate the risk of bloodstream infections.

KE. With infusion therapy a purely technological or scientific response will not solve the infection problem. Devices for infusion therapy need to be simple, intuitive and designed to enhance clinical best practices. Just as CHG enhances skin antisepsis, needleless connectors should enhance the process of disinfecting, flushing, and maintaining patency. Needleless access connectors should feature a flat, tightly sealed surface to promote complete disinfection during pre-access swabbing, clear housing to permit complete visualization of the fluid path - enabling proper flushing of the connector and catheter, and positive displacement to assist in maintaining catheter patency.

Both MaxPlus Clear™ and MaxGuard™ from Maximus are designed with these risk reducing features. Maximus is active in providing Continuing Education programs, training services and support for the bedside clinician; we also offer a comprehensive CLABSI prevention program that can be customized to the needs of any facility and assist hospitals in meeting the Joint Commission National Patient Safety Goals. This program can be easily implemented in a hospital and provides a valuable service to the often overwhelmed Infection Prevention and Risk Management Departments.

As the pace of medical innovation increases, do you anticipate new challenges on the horizon with regard to the prevention and management of infectious complications resulting from the use of intravascular catheters?
MH. I predict that we will have challenges with regard to the prevention and management of infections resulting from intravascular catheters. However, I do feel that it will continue to decrease and believe that this could become a complication of the past within my lifetime. A caveat to this is that both the medical field and industry must work together with the common goal to improve patient outcomes. I think Dr. Allan Fromme said it best: "People have been known to achieve more as a result of working with others than against them."

KE. Yes. New innovations designed to help prevent transmission of infection causing pathogens may lead clinicians to believe that best practices are not as important or do not need to be performed as well. This is a challenge for manufacturers of antimicrobial devices and other technologies designed to reduce the risk of infection. As manufacturers it is important that we stress that the use of new technologies will never replace the need to perform best practices. Best practices such as hand hygiene, skin antisepsis, scrubbing/disinfecting the hub of the needleless access connector and completely flushing the catheter and connector are key to successful CLABSI prevention. Maximus strives to design devices and educational programs that support and sustain best nursing practices, because these must be maintained and sustained in order for hospitals to reach the goal of zero nosocomial infections. 

Mark Hunter is Associate Director in Clinical Development for Baxter, working with product development and educational programs in infusion therapy. He has over 20 years experience as a registered nurse, is certified in infusion nursing, has been involved with the Infusion Nursing Society at the local and national levels and contributed to the INS Standards of Practice.

Kerry Edgar is the Vice President of Marketing and Clinical Affairs for Medegen Inc., developer of Maximus line of IV therapy products. She has worked in the health care industry for 22 years, in marketing, clinical, and sales capacities. For the past five years, Edgar has directed the marketing and clinical affairs for Medegen Inc.