Analyse des coûts et avantages des pansements transparents, des pansements de gaze et de l’option sans pansement en présence d’un CVC tunnellisé chez les receveurs de greffe de cellules souches au Canada

Melanie Keeler, Barbara K. Haas, Sally Northam, Michael Nieswiadomy, Charles McConnel, Lynn Savoie

Abstract


La bactériémie associée aux cathéters veineux centraux (BACC), un risque évitable en soins infirmiers en oncologie, est une cause de morbidité chez les patients et accroît les dépenses en soins de santé. Les objectifs de l’étude étaient d’évaluer l’incidence de trois stratégies infirmières différentes pour le site de sortie du cathéter veineux central (CVC) sur les résultats en matière d’infection et de comparer les coûts associés à chaque stratégie. Selon l’hypothèse de l’étude, les taux de BACC et les coûts afférents aux soins infirmiers diffèrent chez les adultes du Canada qui reçoivent des greffes de cellules souches par le biais d’un CVC tunnellisé en association avec un pansement transparent ou un pansement de gaze ou encore l’option sans pansement. Un échantillon de 432 dossiers d’un seul centre a permis de comparer les taux de BACC entre ces groupes de pansement. Le calcul des coûts sur une base individuelle a été utilisé pour estimer les frais de fourniture des pansements en vue d’évaluer les coûts et avantages de chacune des stratégies de prise en charge du site de sortie. Les résultats de l’étude révélaient qu’il n’existait pas de différences significatives, entre les trois stratégies de pansement, sur le plan des BACC, du nombre d’organismes, des résultats de la coloration de Gram ou du nombre de jours précédant l’apparition d’une infection. Le pansement de gaze revenait à bien plus cher que le pansement transparent et que l’option sans pansement. En ce qui concerne les frais de fournitures et de main-d’œuvre infirmière, les pansements transparents étaient les plus économiques, suivis de près par la stratégie sans pansement. La stratégie sans pansement était, semble-t-il, la meilleure option globale puisque le retrait des pansements présente plusieurs autres avantages monétaires et non monétaires mais de trop grande envergure pour pouvoir être mesurés dans le cadre de la présente étude.


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References


Bard Access Systems (2012a). Hickman* / Broviac* / Leonard* Catheters. Retrieved from http://www.bardaccess.com/picc-hick-brov-leon.php?section=Features

Bard Access Systems (2012b). How to care for your groshong catheter. Retrieved from http://www.bardaccess.com/assets/pdfs/patient/pg-grosh-cath.pdf

Battistella, M., Bhola, C., & Lok, C.E. (2011). Long-term follow-up of the hemodialysis infection prevention with polysporin ointment (HIPPO) study: A quality improvement report. American Journal of Kidney Disease, 57(3), 432–441.

Beck, C. (1895). A manual of the modern theory and technique for surgical asepsis. Philadelphia: W.B. Saunders. Digitized by Google. Retrieved from http://books.google.com.mx/books?id=

qM3njRbYkVQC&printsec=frontcover#v=onepage&q&f=false

British Columbia Nurses’ Union (2012). Collective agreement. Retrieved from https://www.bcnu.org/ContractAdministration/ContractAdministration.aspx?page=Collective%20Agreements

Chopra, V., Krein, S.L., Olmsted, R.N., Safdar, N., & Saint, S. (2013). Prevention of central line-associated bloodstream infections: Brief update review. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Agency for Healthcare Research and Quality, No.211. Rockville MD: USA. Available from http://www.ncbi.nlm.nih.gov/books/NBK133364/

Daniels, K.R., & Frei, C.R. (2012). Antimicrobial impregnated discs for prevention of intravenous catheter-related infections. American Journal of Infectious Disease, 8(1), 50–59.

Duval, L. (2010). Infection control 101. Nephrology Nursing Journal, 37(5), 485–489.

Faruqi, A., Medefindt, J., Dutta, G., Philip, S.A., Tompkins, D., & Carey, J. (2012). Effect of a multidisciplinary intervention on central line utilization in an acute care hospital. American Journal of Infection Control, 40, e211–215.

Field, A. (2009). Discovering statistics using SPSS (3rd ed.). Thousand Oaks, CA: Sage Publishing.

Gillies, W.J., O’Riordan, E., Sheriff, K.L., & Rickard, C.M. (2011). Gauze and tape and transparent polyurethane dressings for central venous catheters. Cochrane Database of Systematic Reviews, 3. doi:10.1002/14651858.CD003827.pub2

Infusion Nurses Society. (2011). Policies and procedures for infusing nursing. (4th ed.). Philadelphia: Lippincott, Williams & Wilkins.

International Business Machines Corporation. (2012). Statistical package for the social sciences v.21. USA: Microsoft Corp.

Institute for Health Improvement. (2013). Central line catheter-related bloodstream infection (CR-BSI) rate per 1,000 central line days. Retrieved from http://www.ihi.org/knowledge/Pages/Measures/CatheterRelatedBloodstreamInfectionRate.

Joint Commission. (2012). Preventing central line-associated bloodstream infections: A global challenge, a global perspective. Oak Brook, IL: Joint Commission Resources. Retrieved from http://www.PreventingCRBSIs.pdf.

Keeler, M.E. (2014). La pratique liée aux cathéters veineux centraux dans les greffes de keeffasdfasdf infirmiers en oncologie, 24(2), 72–77.

Keeler, M.E., Haas, B.K., Nieswiadomy, M., McConnel, C, Northam, S., & Savoie, M.L. (2015). Bactériémies associées aux cathéters veineux centraux chez les receveurs canadiens de cellules souches sanguines : coûts connexes. Revue canadienne de soins infirmiers en oncologie, 25(3), 319–327.

Kwakman, P.H., Müller, M.C., Binnekade, J.M., van den Akker, J.P., de Borgie, C.A, Schultz, M.J., … Zaat, S.A. (2012). Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: A randomized controlled trial. Critical Care, 16(5), R214.

Macklin, D. (2010). Catheter management. Seminars in Oncology Nursing, 26(2), 113–120.

Manitoba Nurses Union (2012). Collective agreement. Retrieved from http://www.nursesunion.mb.ca/resources/collective-agreement/wage-benefit-summary.html

Medeiros, A.B., dos Santos, A.A., Soares, M.J., Costa, M.M., & Lira, A.L. (2012). Wound dressing technique: Comparative study between nursing professionals and students. Journal of Nursing UFPE online, 6(6), 1352–1360. doi:10.5205/01012007

Mermel, L.A., Allon, M., Bouza, E., Craven, D.E., Flynn, P., O’Grady, N., … Warren, D.K. (2009). Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clinical Infectious Disease, 49(1), 1–45.

Møller, T., & Adamsen, L. (2010). Hematologic patients’ clinical and psychosocial experiences with implanted long-term central venous catheter: Self-management versus professionally controlled care. Cancer Nursing, 33(6), 426–435.

Moreau, N. (2009). Are your skin-prep and catheter techniques up to date? Nursing, 39(5), 15–16.

New Brunswick Nurses Union (2013). Collective agreement. Retrieved from https://www.nbnu.ca/nurses-part-iii/

Newfoundland and Labrador Nurses’ Union (2011). Collective agreement. Retrieved from http://www.nlnu.ca/collective-agreements.asp

Nova Scotia Nurses Union (2013). Collective agreement. Retrieved from http://www.nsnu.ca/en/home/collectiveagreements/default.aspx

O’Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., O’Heard, S., … Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. American Journal of Infection Control, 39, S1–34.

Olsin, K., Rennie, R.P., Hanson, J., Ryan, M., Glipin, J., Falsetti, M., … Gaudet, S. (2004). Evaluation of a no-dressing intervention for tunnelled central venous catheter exit sites. Journal of Infusion Nursing, 27(1), 37–44.

Ontario Nurses Association (2013). Collective agreement. Retrieved from http://www.ona.org/ona_members/hospital.html

Pallo, R.J. (2012). Organization and training for aseptic operations. Journal of GXP Compliance, 16(2), 43–46.

Petrasiano, B., Becker, H., & Christian, B. (1988). Infection rates in central venous catheter dressings. Oncology Nursing Forum, 115, 709–717.

Poole, D. (2010). Minimizing the risk of infection in patient with central venous catheters. British Journal of Cardiac Nursing, 5(10), 477–481.

Popovich, K.J., Hova, B., Hayes, R., Weinstein, R.A., & Hayden, M.K. (2010). Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit. Intensive Care Medicine, 36, 854–858.

Prince Edward Island Nurses’ Union (2011). Collective agreement. Retrieved from http://peinu.com/member-services/collective-agreementnegotiations/

Programme canadien de surveillance des infections nosocomiales. (2005). Bactériémies associées aux cathéters veineux centraux dans les unités de soins intensifs et chez les receveurs de greffes de cellules souches hématopoïétiques. Archives de l’Agence de la santé publique du Canada, Ottawa, Ontario.

Raschka, S., Dempster, L., & Bryce, E. (2013). Health economic evaluation of an infection prevention and control program: Are quality and patient safety programs worth the investment? American Journal of Infection Control, 41(9), 773–777.

Rodriguez, L., Ethier, M-C., Phillips, B., Lehrnbecher, T., Doyle, J., & Sung, L. (2012). Utility of peripheral blood cultures in patients with cancer and suspected blood stream infections: A systematic review. Supportive Care in Cancer, 20(12), 3261–3267.

Saskatchewan Union of Nurses (2012). Collective agreements. Retrieved from http://sun-nurses.sk.ca/labour-relations/collective-agreements

Santerre, R.E., & Neun, S.P. (2010). Health economics: Theory, insights, and industry studies. Mason, OH: Cengage Learning.

Scales, K. (2010a). Central venous access devices part 1: Devices for acute care. British Journal of Oncology Nursing, 19(2), 88–92.

Scales, K. (2010b). Central venous access devices: Part 2 for intermediate and long-term use. British Journal of Oncology Nursing, 19(5), S20–25.

Scales, K. (2011). Reducing infection associated with central venous access devices. Nursing Standard, 25(36), 49–56.

Seiler, S., & Pember, A. (2012). Editorial: Shower and no-dressing technique for tunnelled central venous hemodialysis catheters: 2012 — an update. CANNT: Canadian Association of Nephrology Nurses and Technologists Journal, 22(2), 16.

Tarricone, R., Torbica, A., Franzetti, F., & Rosenthal, V.D. (2010). 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 Effectiveness Resource Allocation, 8(8). doi:10.1186/1478-7547-8-8

Tomblyn, M., Chiller, T., Einsele, H, Gress, R., Sepkowitz, K., Storek, J., & Boeckh, M.A. (2009). Guidelines for preventing infectious complications among hematapoietic cell transplant recipients: A global perspective. Biology Blood Marrow Transplant, 15, 1143–1238.

Toscano, C.M., Bell, M., Zukerman, C., Sheltor, W., Novicki, T.J., Nichols, W.G., & Jarvis, W.R. (2009). Gram-negative blood stream infections in hematapoietic stem cell transplant patients: The roles of needless device use, bathing practices, and catheter care. American Journal of Infection Control, 37, 327–334.

Toshiyuki, N., Koshuka, S., Toshihasa, A., Yoshikawa, T., Fakuda, K., & Satu T. (2012). Low incidence of catheter-related complications in patients with advanced pulmonary arterial hypertension undergoing continuous epoprostenol infusion. Chest, 14(1), 272–273.

United Nurses of Alberta (2010). Collective agreements. Retrieved from http://www.una.ab.ca/collectiveagreements


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