Santral Venöz Kateter Bakımında Kullanılan Standart Bakım ile Transparan Film Örtülerin Etkinliklerinin Karşılaştırılması: Olgu Kontrol Çalışması

Abstract

Bu çalışma, santral venöz kateter (SVK) bakımında kullanılan standart bakım ile klorheksidin glukonat içeren transparan film örtülerin etkinliğinin kateter enfeksiyonu, bakım maliyeti, hemşire memnuniyeti ve verimliliği açısından karşılaştırılması amacıyla gerçekleştirildi. Çalışmanın evrenini, bir devlet hastanesinin Genel Yoğun Bakım Ünitesi'nde yatan hastalar ile bu ünitede çalışan hemşireler oluşturdu. Mart- Aralık 2020 tarihleri arasında olgu kontrol tipinde gerçekleştirilen çalışmada, kontrol grubuna standart SVK bakımı, olgu grubuna klorheksidin içeren transparan film örtüler ile SVK bakımı uygulandı. Veriler, hasta dosyalarından, hemşire gözlem formlarından, hemşireler ile birebir yüzyüze görüşerek ve enfeksiyon kontrol komitesinden sürveyans bilgileri alınarak araştırmacı tarafından toplandı. Verilerin analizi bir istatistik programından yardım alınarak yapıldı. Olgu grubunda SVK kullanım oranı 0,66 kontrol grubunda ise SVK kullanım oranı 0,55 olarak hesaplandı. Olgu grubunda SVK kullanım oranı kontrol grubuna göre fazla (p<0,05) olmasına karşın, santral venöz katater ile ilişkili kan dolaşımı enfeksiyonu gelişimi görülmedi. Olgu grubunda 77, kontrol grubunda ise 293 pansuman yapıldı. Kontrol grubunda rutin değişim, kirlilik, gevşeme nedeniyle olgu grubuna göre, olgu grubunda ise ıslaklık nedeniyle kontrol grubuna göre daha fazla pansuman gerçekleştiği görüldü. Buna rağmen, klorheksidin glukonat içeren şeffaf pansumanların maliyet etkinliği daha iyi bulundu. Bununla birlikte, klorheksidin glukonat içeren şeffaf pansumanların kullanılması hemşire memnuniyeti ve verimliliğini artırdığı görüldü. Şeffaf pansumanlar enfeksiyon açısından gazlı bezden önemli ölçüde farklı değildi. Klorheksidin glukonatlı şeffaf pansumanlar sınırlı maliyet etkinliği gösterirken, hemşire memnuniyeti ve verimliliğine olumlu katkıda bulundu.

Keywords

• Santral Venöz Kateter
• Pansuman
• Kateter
• Enfeksiyon
• Yoğun Bakım
• Maliyet

Effectiveness of Transparent Dressing with Chlorhexidine Gluconate for Central Venous Catheter Care in the Intensive Care Unit: A Case Control Study

Abstract

The objective of this study was to compare the efficacy of standard care and transparent film dressings containing chlorhexidine gluconate in the management of central venous catheters (CVCs) in terms of catheter-related infection, cost of care, nurse satisfaction and efficiency. The study population comprised patients hospitalised in the General Intensive Care Unit of the State Hospital, and nurses employed in this unit. In the case-control study conducted between March and December 2020, the control group received standard CVC care, while the case group received CVC care with transparent film covers containing chlorhexidine. The data were collected by the researcher from patient files, nurse observation forms, face-to-face interviews with nurses, and surveillance information from the infection control committee. The data were analysed using a statistical software program. The rate of CVC utilisation in the case group was 0.66, while the rate of CVC utilisation in the control group was 0.55. Despite the higher rate of CVC use observed in the case group compared to the control group (p < 0.05), there was no evidence of catheter-related bloodstream infection. A total of 77 dressings were performed in the case group, compared to 293 in the control group. It was observed that a greater number of dressings were performed in the control group than in the case group, due to the need for routine changes, the presence of contamination and loosening. Conversely, a greater number of dressings were performed in the case group than in the control group, due to the presence of wetness. However, the cost-effectiveness of transparent dressings containing chlorhexidine gluconate was found to be superior. Nevertheless, the utilisation of transparent dressings containing chlorhexidine gluconate appeared to enhance nurse satisfaction and efficiency. Transparent dressings demonstrated no significant distinction from gauze in terms of infection. While transparent dressings with chlorhexidine gluconate exhibited limited cost-effectiveness, they contributed favourably to nurse satisfaction and efficiency.

Keywords

• Central Venous Catheter
• Dressings
• Catheter
• Infection
• Intensive Care
• Cost

References

1. Akdemir, M. S., Tarıkçı Kılıç, E., Kılıç, H., & Altınel, S. (2018). Our experiences in central venous catheterization in intensive care unit: Retrospective Evaluation. Anaesth Intensive Care Soc, 24(1), 29–34.
2. Çam, R., Dönmez, Y. C., & Demİr, F. (2008). The Investigation of Characteristics and Complications of Central Venous Catheters in Intensive Care Units. Journal of the Türkish Society of Critical Care Nursing, 12(1–2), 17–22.
3. Celebi, E., & Ilce, A. (2022). Determınatıon Of Knowledge Levels Of Nurses Workıng In Surgıcal Clınıcs About Eras Protocols. Sağlık , Bakım ve Rehabilitasyon Dergisi, 1(1), 012–024.
4. Çetinkaya Şardan, Y., Güner, R., Çakar, N., Ağalar, F., Bolaman, Z., Yavaşoğlu, İ., Kunt, A., & Yılmaz, G. R. (2013). Damar içi kateter infeksiyonlarının önlenmesi kılavuzu. Hastane İnfeksiyonları Dergisi, 17(2), 233–279.
5. Comerlato, P. H., Rebelatto, T. F., Santiago de Almeida, F. A., Klein, L. B., Boniatti, M. M., Schaan, B. D., & Rados, D. V. (2017). Complications of central venous catheter insertion in a teaching hospital. Revista Da Associação Médica Brasileira, 63, 613–620.
6. Corley, A., Ullman, A. J., Mihala, G., Ray-Barruel, G., Alexandrou, E., & Rickard, C. M. (2019). Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: A secondary analysis of 40,637 catheters. International Journal of Nursing Studies, 100. https://doi.org/10.1016/j.ijnurstu.2019.103409
7. Deutsch, G. B., Sathyanarayana, S. A., Singh, N., & Nicastro, J. (2014). Ultrasound-guided placement of midline catheters in the surgical intensive care unit: a cost-effective proposal for timely central line removal. Journal of Surgical Research, 191(1), 1–5.
8. Dönmez, B., Öztürk, C., Kahraman, G., Keskin, B., & Kayabaşı, E. (2021). Antibiotic Resistance Rates of Pseudomonas Aeruginosa Strains Isolated from Clinical Sample. Abant Medical Journal, 10(2), 258–265.

9. Düzkaya, D. S., Sahiner, N. C., Uysal, G., Yakut, T., & Çitak, A. (2016). Chlorhexidine-impregnated dressings and prevention of catheter-associated bloodstream infections in a pediatric intensive care unit. Critical Care Nurse, 36(6), e1–e7.
10. Eren, O. Ö., Kalyoncu, U., Andiç, N., & Çetinkaya Şardan, Y. (2010). Factors Affecting Cost Of Patient Care in Intensıve Care Unit. Selcuk Medical Journal, 25(4), 195–202. https://www.selcukmedj.org/yogun-bakim-unitesinde-hasta-maliyetini-etkileyen-faktorler-tr-4281
11. Ergül, A. B., Özcan, A., Aslaner, H., Aslaner, H. A., Köse, S., Coskun, R., & Torun, Y. A. (2016). Evaluation of central venous catheterization complications and related risk factors in a pediatric intensive care unit. Journal of Critical and Intensive Care, 7(1), 9.
12. Ho, K. M., & Litton, E. (2006). Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. Journal of Antimicrobial Chemotherapy, 58(2), 281–287.
13. Karadağ, A. (1999). Dressing Materials Which are Used in Intravenous Catheter Insertion. (Journal of Cumhuriyet University School of Nursing, 3(2), 35–39.
14. Karayavuz, A. (2006). Kateter Hemşireliği. Türk Hematoloji Derneği Kurs Kitabı, 58–61.
15. Kıray, S., Yıldırım, D., Özçiftçi, S., Akın Korhan, E., & Uyar, M. (2019). The Effect of Central Venous Catheter Care on Infection Development: A Systematic Review. Turkish Journal of Intensive Care, 17(2), 60–74. https://doi.org/10.4274/tybd.galenos.2019.02418
16. Lopez, V. (2015). Implementing evidence-based practice to develop nursing curriculum. Nursing Practice Today, 2(3), 85–87.
17. Lorente, L. (2015). chlorhexidine-impregnated dressings reduce risk of colonisation of central venous catheters and risk of catheter-related bloodstream infection. Evidence-Based Nursing, 18(3), 91.
18. Maunoury, F., Motrunich, A., Palka-Santini, M., Bernatchez, S. F., Ruckly, S., & Timsit, J.-F. (2015). Cost-effectiveness analysis of a transparent antimicrobial dressing for managing central venous and arterial catheters in intensive care units. PLoS One, 10(6), e0130439.
19. Niemann, B., Dudas, L., Gray, D., Pettit, A., Wilson, A., & Bardes, J. M. (2022). Biofilm Formation on Central Venous Catheters: A Pilot Study. Journal of Surgical Research, 280, 123–128. https://doi.org/10.1016/j.jss.2022.06.072
20. O’grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Lipsett, P. A., Masur, H., Mermel, L. A., & Pearson, M. L. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), e162–e193.
21. Pedrolo, E., Danski, M. T. R., Wiens, A., & Boostel, R. (2018). Cost effectiveness of dressing in the prevention of catheter-related infection in critically ill patients. The Journal of Infection In Developing Countries, 12(10), 871–877.
22. Richardson, A., Melling, A., Straughan, C., Simms, L., Coulter, C., Elliot, Y., Reji, S., Wilson, N., Byrne, R., & Desmond, C. (2015). Central venous catheter dressing durability: an evaluation. Journal of Infection Prevention, 16(6), 256–261.
23. Safdar, N., O’Horo, J. C., Ghufran, A., Bearden, A., Didier, M. E., Chateau, D., & Maki, D. G. (2014). Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Critical Care Medicine, 42(7), 1703.
24. Şanli, D., Sarikaya, A., & Katircioğlu, K. (2016). A review of the effectiveness of evidence-based recommendations for prevention of catheter related bloodstream infections in intensive care unit patients. Medical Journal of Bakirkoy, 12(4), 163–187. https://doi.org/10.5350/BTDMJB201612402
25. Sanlı, D. (2017). The effect of care for intensive care patients using the translating evidence into practice model on preventing central venous catheter related infections. Dokuz Eylul University.
26. Sanlı, D., & Sarıkaya, A. (2016). Evidenced-Based Nursing Care Management at Central Venous Catheters. Journal of the Türkish Society of Critical Care Nursing, 20(2), 84–97.
27. Schwebel, C., Lucet, J.-C., Vesin, A., Arrault, X., Calvino-Gunther, S., Bouadma, L., & Timsit, J.-F. (2012). Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study. Critical Care Medicine, 40(1), 11–17.
28. Sherifali, D. (2020). The year of the nurse, Florence Nightingale and COVID-19: reflections from social isolation. Canadian Journal of Diabetes, 44(4), 293–294.
29. Smith, R. N., & Nolan, J. P. (2013). Central venous catheters. BMJ, 347. https://doi.org/10.1136/bmj.f6570
30. Thokala, P., Arrowsmith, M., Poku, E., Martyn-St James, M., Anderson, J., Foster, S., Elliott, T., & Whitehouse, T. (2016). Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients. Journal of Infection Prevention, 17(5), 216–223.
31. Timsit, J.-F., Schwebel, C., Bouadma, L., Geffroy, A., Garrouste-Orgeas, M., Pease, S., Herault, M.-C., Haouache, H., Calvino-Gunther, S., & Gestin, B. (2009). Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. Jama, 301(12), 1231–1241.
32. Tsuchida, T., Makimoto, K., Toki, M., Sakai, K., Onaka, E., & Otani, Y. (2007). The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison. International Journal of Nursing Studies, 44(8), 1324–1333.
33. Ullman, A. J., Cooke, M. L., Mitchell, M., Lin, F., New, K., Long, D. A., Mihala, G., & Rickard, C. M. (2016). Dressing and securement for central venous access devices (CVADs): A Cochrane systematic review. International Journal of Nursing Studies, 59, 177–196.
34. Yadigar, A., Aygün, H., Yalcınbas, Y., Demet, S., & Ulukol, A. (2013). Comparison of catheter related infection rates in pediatric cardiovascular surgery patients with use of transparent cover and transparent cover saturated with chlorhexidin gluconate in central catheter care. Journal of Research and Development in Nursing, 15(2), 57–67.
35. Yeşil, Ş., Tanyıldız, H. G., Ardıçlı, B., Tekgunduz, S. A., Çandır, M. O., Toprak, Ş., Bozkurt, C., & Şahin, G. (2014). Central Venous Catheter-Related Complications. Gazi Medical Journal, 25(4), 135–137.
36. Yu, K., Lu, M., Meng, Y., Zhao, Y., & Li, Z. (2019). Chlorhexidine gluconate transparent dressing does not decrease central line‐associated bloodstream infection in critically ill patients: A randomized controlled trial. International Journal of Nursing Practice, 25(6), e12776.