SCCM Resource Library-We Don't Have It: The Historical Implications in Catheter Technologies and Alternatives Among Resource-Limited ICUs and Infections

Video Transcription

Welcome to the 51st Critical Care Congress, and on this session, Successful Strategies in Catheter-Based Infections, Preventing Healthcare Disparities.  Thank you for attending the group of presentations today. The first presentation is We Don't Have It, The Historical Implications  in Catheter Technologies and Alternatives Among Resource-Limited ICUs and Infections.  I really have nothing to disclose today, especially any relationships with corporations or businesses. I am a subject matter expert on CAUTI and CLABSI, especially working with  the initiative with the Society of Critical Care Medicine, along with AHRQ and the American Hospital Association.  We have much to cover today. If we think about the historical implications of catheter technologies, especially globally,  there have been creative solutions to disease and pathology over the centuries. And in areas with so much variation and available resources.  This list of objectives we should be able to cover today.  And I want to mention this quote because I do think it is very important, and I will readdress it where its origin is later in the presentation.  The majority of the world population lives in low- to middle-income countries.  And the majority of their population are at risk of developing hospital-acquired infections.  How providers structure their ICUs allows our approach to improve patient safety, regardless  of the resources, with specific processes, and allowing that patient safety focus mindfulness.  It's important to understand the history of catheters. Most were developed at times when resources were limited and were utilized to solve solutions  or patient problems, as well as to prevent harm.  Catheters were used as early as 3000 BC to relieve painful urinary retention.  Many cultures use different materials, whether it be palm leaves to tops of onions to different metals.  Malleable catheters were developed in the 11th century. Benjamin Franklin used silver catheters and developed one for use by his older brother who suffered from kidney stones.  River vulcanization, a good year in 1844, improved the firmness and durability and allowed for mass production.  And Dr. Frederick Foley introduced the latex balloon catheter at a urologic convention in 1935.  Historically, the same goes with vascular catheters. They were developed from simple materials like reeds or glass to introduce solutions into a patient's body.  The first documented indwelling central venous catheter was created by Dr. Stanley Duderich in 1967, and each of these other catheters that were produced were basically created  to solve a problem or to prevent patient harm.  Each of the catheters developed by the specific physicians were really created to solve a safety problem, and they used the materials at hand.  I have found over the years that all of us work as teams to solve problems in the ICU utilizing guidelines for patient safety.  Years ago, I had a discussion with an ICU director from South America, and their ICU was able to reduce their catheter-related infections by over 75%, which is very meaningful,  but even more so because they only had six central line catheters and one pulmonary artery catheter to use in their ICU, and they had to find a way to reuse those devices, maintain  sterility, and reduce patient harm.  They couldn't just replace them, and what was amazing, they looked and utilized the Tier 1 and Tier 2-type processes to utilize those catheters and prevent infections in  their population.  Now, some ICUs have a plethora of catheters and still have significant infections, yet  many times with limited resources, it allows ICUs to really look and focus on what's important and what matters to reduce infection.  This is the quote that this ICU director gave to me, in that we can still maintain patient safety while being focused on processes, even when we are faced with limited resources.  By focusing on the tiered approaches for infection prevention, we can really reduce patient harm.  The Tier 1 processes, focusing on supplies, procedures, processes, and utilizing the patient safety goals, and then there's Tier 2 processes, such as enhanced practices, the  adaptive processes to change the unit culture.  These are such as catheter rounds, the root cause analyses to focus on infection reduction. That ICU director in South America, they were able to use the RCAs to focus on what part  of their processes on the limited catheters that they had that they could address and change the behavior of the ICU.  I wanted to mention how even in ICUs with first world resources, there is a significant amount of research surrounding bias and inequities in hospital-acquired infections.  This article published last year showed these factors that are mentioned that contribute to inequities in these infections and their prevention.  In summary, this article looked at the measures to mitigate inequities, and these included teaching healthcare providers how to recognize and mitigate unconscious biases, expanding  community resources which address the social and structural determinants of health, increasing  access to preventative health services, reforming federal and institutional policies to better  support a safety net hospital, and then finally, how to address inequities in the hospital and disincentivize the price discrimination, as well as improving diversity and inclusion  within the health workforce.  Other articles have shown the importance of understanding race-specific comorbidities  in dealing with the central line catheter infections.  In this article, it was suggested a need for race-specific covariate adjustments in patient outcomes, really to provide a new context for examining racial disparities.  In this article, the study showed that some comorbid conditions and patient characteristics  that are associated with the patterns of comorbid conditions are important determinants of hospital-level  patient safety outcomes, and showed that we all need to be aware of these patterns and strive to allocate resources to those with the need, regardless of any bias.  In the next few slides, I want to refer to you to this website. It's a new site by the American Hospital Association and addresses the collaboration and potential  solutions using data to drive action.  It's set up to address equitable and inclusive organizational policies. The Health Equity Roadmap is a national initiative to drive improvement in health care outcomes,  health equity, diversity, and inclusion.  The Equity Roadmap is a framework to help hospitals and health care systems chart their own paths toward transformation, thus becoming more equitable and inclusive organizations.  The Health Equity Roadmap is a national initiative to drive improvement in health care outcomes,  Once logged on to the website, if you navigate down to the Health Equity Action Library, you will find guides and toolkits on six of the key resource areas.  Collection and use of data to drive action, community collaboration for solutions, culturally appropriate patient care, diverse representation and executive leadership and  governance, equitable and inclusive organizational policies, systematic and shared accountability,  This is a new and focused initiative by the American Hospital Association and will allow understanding of the historical implications of catheter use and development and infection  prevention, with creative solutions to improve patient safety, allowing standards of care and preventing disparities.  Utilizing this roadmap, we could develop truly equitable and inclusive protocols and policies regardless of an ICU's location or their resource availabilities.  This was published last year and shows especially after a pandemic and with limited resources, the worldwide peripheral intravenous catheter industry is exploding.  What's driving the growth is trying to reduce infections, improve resources, and especially around midline intravenous catheters.  They are unique in that they are inserted peripheral lines but terminate in the central vein and can reduce the CLABSI risk.  More ICUs globally are actually using midlines due to better availability and reduced infections.  They are less expensive and more available than the standard central line catheters.  If we think about it, ICUs across the world have always had resource limitations. Some more than others.  The COVID pandemic has been a catalyst for change and has highlighted shortages and limited resources as well as the use of alternatives in what is available.  We also have creativity and focused teamwork to solve problems and reduce patient harm.  These processes and protocols focused on patient safety allows any ICU, regardless of resources, to reduce catheter-related hospital-acquired infections.  We need to strive to reduce inequities globally and regionally, and even with limited resources, develop processes to reduce those infections and improve patient safety.  There have been many implications in the development of catheter technologies over the centuries.  We do not go into all the current alternatives since they will be covered in the other presentations.  But depending on whether you are in sub-Saharan Africa or downtown LA, resource limitations and bias may exist.  We need to understand how to eliminate that bias and provide resources to all those in need, and still be creative and patient safety focused.  We need to provide the patient and provider education on adaptive solutions.  This will be the key to solve much of the resource limitations.  I go back to this quote and restate it. This quote is from the ICU director in that extremely resource-limited ICU.  And what he told me that made such an impact for me is that we can still maintain patient safety  while being focused on processes, even when we are faced with the limited resources in our ICU.  I invite you to listen to the next presentations, What Can We Do With What We Have? The Global Prevention Strategies to Reduce Catheter-Based Infections by Kathleen Vollman,  and What We Promote, Developing and Maintaining a Culture of Patient Safety in Diverse ICUs by Patricia Poza.  Thank you.

Video Summary

The video transcript discusses the historical implications of catheter technologies and the challenges faced in resource-limited ICUs. It emphasizes the importance of patient safety and reducing hospital-acquired infections. The use of different materials for catheters is highlighted, as well as the development of safer and more effective catheter designs over time. The transcript also addresses the issue of healthcare disparities and bias in infection prevention. The speaker mentions strategies such as utilizing tiered approaches for infection prevention and addressing inequities in healthcare. The importance of data collection, collaboration, and diversity in healthcare organizations is highlighted. The transcript concludes by mentioning alternative catheter options and the need for creativity and adaptive solutions to overcome resource limitations and provide equitable patient care.

Asset Subtitle

Infection, Professional Development and Education, Quality and Patient Safety, 2022

Asset Caption

Hospital-acquired infections (HAIs) cause serious harm in ICUs across the world. Many successful strategies initiated in resource-limited areas have been proven to mitigate infections and are cost-effective. This session will highlight how healthcare systems with disparate levels of resources can apply successful strategies to prevent harm from catheter-based HAIs.

Meta Tag

Content Type Presentation

Knowledge Area Infection

Knowledge Area Professional Development and Education

Knowledge Area Quality and Patient Safety

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Nosocomial Infection

Tag Healthcare Delivery

Tag Evidence Based Medicine

Year 2022

Keywords

catheter technologies

patient safety

hospital-acquired infections

healthcare disparities

alternative catheter options

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