TY - JOUR
T1 - An Interventional Controlled Trial Comparing 2 Management Models for the Treatment of Tunneled Cuffed Catheter Bacteremia
T2 - A Collaborative Team Model Versus Usual Physician-Managed Care
AU - Mokrzycki, Michele Helene
AU - Zhang, Meilin
AU - Golestaneh, Ladan
AU - Laut, Jeffrey
AU - Rosenberg, Stuart O.
N1 - Funding Information:
Support: Funded by a grant from the Aetna Foundation Inc. Potential conflicts of interest: None.
PY - 2006/10
Y1 - 2006/10
N2 - Background: The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC). Methods: INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group. Results: Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 21/2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6% versus UC, 18%; odds ratio, 0.28; 95% confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0% versus UC, 6%; P < 0.02). In INT units, there was a 45% decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73% decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02). Conclusion: Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.
AB - Background: The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC). Methods: INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group. Results: Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 21/2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6% versus UC, 18%; odds ratio, 0.28; 95% confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0% versus UC, 6%; P < 0.02). In INT units, there was a 45% decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73% decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02). Conclusion: Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.
KW - Tunneled catheter
KW - bacteremia
KW - health care team effectiveness
KW - hemodialysis (HD)
UR - http://www.scopus.com/inward/record.url?scp=33748753253&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33748753253&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2006.06.009
DO - 10.1053/j.ajkd.2006.06.009
M3 - Article
C2 - 16997055
AN - SCOPUS:33748753253
SN - 0272-6386
VL - 48
SP - 587
EP - 595
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -