Closed system for the safe management of intravenous fluids and the reduction of healthcare-associated bloodstream infections
DOI:
https://doi.org/10.56294/saludcyt20241052Keywords:
Catheters, Central Venous Catheters, Catheter-Related Infections, Closed SystemsAbstract
Introduction: the use of closed infusion systems for the administration of intravenous fluids has shown a notable impact on reducing Central Line-Associated Bloodstream Infections (CLABSI); however, their adoption in Chile remains limited. Objective: This study aimed to assess the role of closed infusion systems in preventing CLABSI.
Methods: a rapid literature review was conducted, consulting databases such as Web of Science, SCOPUS, PubMed, SciELO, CINAHL, the Cochrane Library, and BVS. The searches were carried out in the Spanish, English, and Portuguese languages; only studies with a quantitative approach were included, with no time limit and that answered the research question. The Canadian Task Force on Preventive Health Care criteria were utilized to analyze the level of evidence and grade of recommendation.
Results: out of the nine articles reviewed, 11 % presented Level IA evidence, and 88,9 % presented evidence and a recommendation grade of IIB, indicating that patients receiving intravenous fluids through open containers are at a two to five times higher risk of developing CLABSI compared to those using closed systems.
Conclusion: the employment of closed systems for the administration of intravenous fluids via CVC is associated with a significantly lower risk of acquiring CLABSI compared to the use of open systems. This finding underscores the necessity of promoting the use of closed infusion technologies as a preventative measure in the clinical setting
References
1. Günther SC, Schwebel C, Hamidfar-Roy R, Bonadona A, Lugosi M, Ara-Somohano C, et al. Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study). Intensive Care Med [Internet]. 2016 [consultado 20 de noviembre 2023];42(11): 1753–65. Disponible en: https://doi.org/10.1007/s00134-016-4582-2
2. Centers for Disease Control and Prevention (CDC). Central Line-Associated Bloodstream Infections [Internet]. arpsp.cdc.gov. 2022 [consultado 20 de noviembre 2023]. Disponible en: https://arpsp.cdc.gov/profile/nhsn/clabsi?hidden=#about
3. Ministerio de Salud; Departamento de Calidad y seguridad de la atención, Programa control de IAAS. Informe de vigilancia de Infecciones asociadas a la atención de salud 2020. [consultado 20 de noviembre 2023]. Disponible en: https://www.minsal.cl/wp-content/uploads/2015/09/INFORME-DE-VIGILANCIA-2020.pdf
4. Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control [Internet]. 2020 [consultado 20 de noviembre 2023];48(4): 423–32. Disponible en: https://doi.org/10.1016/j.ajic.2019.08.023
5. Vergara T, Fica A. Estudio de costo de las infecciones del torrente sanguíneo asociadas a catéter vascular central en pacientes adultos en Chile. Rev Chil infectología [Internet]. 2015 [consultado 20 de noviembre 2023];32(6): 634–8. Disponible en: http://dx.doi.org/10.4067/S0716-10182015000700004
6. Sociedad Española de Medicina Preventiva Salud Pública e Higiene y European Centre for Disease Prevention and Control. Estudio EPINE-EPPS 2017. España: Sociedad Española de Medicina Preventiva, Salud Pública e Higiene; 2017 [consultado 20 de noviembre 2023]. 29 p. Disponible en: https://epine.es/docs/public/reports/esp/2017%20EPINE-EPPS%20Informe%20Global%20de%20Espa%C3%B1a%20Resumen.pdf
7. Riu M, Chiarello P, Terradas R, Sala M, Castells X, Knobel H, et al. Impacto económico de las bacteriemias nosocomiales. Comparación de tres metodologías de cálculo. Enferm Infecc Microbiol Clin [Internet]. 2016 [consultado 20 de noviembre 2023];34(10): 620–5. Disponible en: https://doi.org/10.1016/j.eimc.2015.09.007
8. Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg R-P, et al. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. Serra R, editor. PLoS One [Internet]. 2020 [consultado 20 de noviembre 2023];15(1): e0227772. Disponible en: https://dx.plos.org/10.1371/journal.pone.0227772
9. The Joint Commission. Preventing Central Line Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Oak Brook, IL: Joint Commission Resources; 2012 [consultado 20 de noviembre 2023]. 1–152 p.
10. Kato S, Suzuki S, Wakamatsu Y, Kurita K, Shoji C, Tuchiya H. Efforts to Prevent Central Line-Associated Bloodstream Infection in Our Intensive Care Unit. Japanese J Environ Infect [Internet]. 2013 [consultado 20 de noviembre 2023];28(3): 154–60. Disponible en: https://doi.org/10.4058/jsei.28.154
11. Maki DG, Rosenthal VD, Salomao R, Franzetti F, Rangel-Frausto MS. Impact of Switching from an Open to a Closed Infusion System on Rates of Central Line–Associated Bloodstream Infection: A Meta-analysis of Time-Sequence Cohort Studies in 4 Countries. Infect Control Hosp Epidemiol [Internet]. 2011 [consultado 20 de noviembre 2023];32(1):50–8. Disponible en: https://doi.org/10.1086/657632
12. Tapia-Benavente L, Vergara-Merino L, Ignacio Garegnani L, Ortiz-Muñoz L, Loézar Hernández C, Vargas-Peirano M. Rapid reviews: definitions and uses. Medwave [Internet]. 2021 [consultado 20 de noviembre 2023];21(01): e8090–e8090. Disponible en: https://doi.org/10.5867/medwave.2021.01.8090
13. Manterola C, Asenjo-Lobos C, Otzen T. Jerarquización de la evidencia: Niveles de evidencia y grados de recomendación de uso actual. Rev Chil infectología [Internet]. 2014 [consultado 20 de noviembre 2023];31(6): 705–18. Disponible en: http://dx.doi.org/10.4067/S0716-10182014000600011
14. Rangel-Frausto MS, Higuera-Ramirez F, Martinez-Soto J, Rosenthal VD. Should we use closed or open infusion containers for prevention of bloodstream infections? Ann Clin Microbiol Antimicrob [Internet]. 2010 [consultado 20 de noviembre 2023];9(1): 6. Disponible en: https://doi.org/10.1186/1476-0711-9-6
15. Tarricone R, Torbica A, Franzetti F, Rosenthal VD. Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy. Cost Eff Resour Alloc [Internet]. 2010 [consultado 20 de noviembre 2023];8(1):8. Disponible en: https://doi.org/10.1186/1478-7547-8-8
16. Franzetti F, Borghi B, Raimondi F, Rosenthal VD. Impact on rates and time to first central vascular-associated bloodstream infection when switching from open to closed intravenous infusion containers in a hospital setting. Epidemiol Infect [Internet]. 2009 [consultado 20 de noviembre 2023];137(7): 1041–8. Disponible en: https://doi.org/10.1017/S095026880800174X
17. Vilins M, Blecher S, Silva MAM da, Rosenthal VD, Barker K, Salomao R. Rate and time to develop first central line-associated bloodstream infections when comparing open and closed infusion containers in a Brazilian Hospital. Brazilian J Infect Dis [Internet]. 2009 [consultado 20 de noviembre 2023];13(5): 335–40. Disponible en: https://doi.org/10.1590/S1413-86702009000500004
18. Rosenthal VD, Maki DG. Prospective study of the impact of open and closed infusion systems on rates of central venous catheter–associated bacteremia. Am J Infect Control [Internet]. 2004 [consultado 20 de noviembre 2023];32(3): 135–41. Disponible en: https://doi.org/10.1016/j.ajic.2003.12.002
19. Mercaldi CJ, Lanes S, Bradt J. Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems. Am J Heal Pharm [Internet]. 2013 [consultado 20 de noviembre 2023];70(11): 957–65. Disponible en: https://doi.org/10.2146/ajhp120464
20. Diana Carolina Velasquez Reyes, Melissa Bloomer, Julia Morphet.Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review, Intensive and Critical Care Nursing, 43, 2017 [consultado 20 de noviembre 2023]:12-22. Disponible en: https://doi.org/10.1016/j.iccn.2017.05.006.
21. Graves N, Barnett AG, Rosenthal VD. Open versus closed IV infusion systems: a state based model to predict risk of catheter associated blood stream infections. BMJ Open [Internet]. 2011 [consultado 20 de noviembre 2023];1(2): e000188–e000188. Disponible en: http://dx.doi.org/10.1136/bmjopen-2011-000188
22. Hersi M, Stevens A, Quach P, Hamel C, Thavorn K, Garritty C, et al. Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review. PLoS One. 2015 [consultado 20 de noviembre 2023];10(10):e 0140290. Disponible en: https://doi.org/10.1371/journal.pone.0140290
23. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health Care–Associated Infections. JAMA Intern Med [Internet]. 2013 [consultado 20 de noviembre 2023];173(22): 2039. Disponible en: https://doi.org/10.1001/jamainternmed.2013.9763
24. Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD, et al. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates. Infect Control Hosp Epidemiol [Internet]. 2014 [consultado 20 de noviembre 2023];35(8):967–77. Disponible en: https://doi.org/10.1086/677216
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Copyright (c) 2024 Naldy Febré, Miguel Valencia-Contrera, Noskar Navarro, Paola Viveros, Marcela Quintanilla6, Andrea Sakurada, Pamela Ivanovic, Teresa Vergara, Cristian Rocco, Katherine Olguín (Author)
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