The introduction of a nutrition clinical nurse specialist results in a reduction in the rate of catheter sepsis.
BACKGROUND
Catheter-related sepsis remains the major confounding factor in the long-term delivery of TPN. Previous studies have shown that the introduction of clinical nurse specialists (CNS) can lead to a reduction in sepsis from TPN catheters. This retrospective study aimed to determine the impact of a nutrition CNS on the rate of catheter-related sepsis. Furthermore, the cost of providing such a service was examined to see if it was offset from the savings obtained from reducing venous access infection.


METHODS
Prior to the employment of a nutrition CNS, the total number of septic catheter complications were retrospectively collected over a 12-month period. Following appointment of the CNS, all patients requiring TPN were prospectively studied for signs of catheter-related sepsis and the data collected over a 4-year period.


RESULTS
The overall sepsis rate (cumulative percentage) fell significantly in the 4-year period after the nutrition CNS was appointed, from 52% to 2.3%. The reduction in venous catheter access was accompanied by a decrease in cost related to wastage of TPN and insertion of new Hickman lines.


CONCLUSIONS
The role of the CNS is primarily to improve the quality of care provided, but also to provide cost effectiveness. We have demonstrated that in addition to reducing infection rate of central venous catheters; the cost of employing a nutrition CNS is almost completely covered by the savings resulting from the reduction in wasted central venous catheters, TPN and operating time.
Sutton
C D
CD
Department of Hepatobiliary and Pancreatic Surgery, The Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
Garcea
G
G
Pollard
C
C
Berry
D P
DP
Dennison
A R
AR
D002408:Catheters, Indwelling / Q000009:adverse effects*; D017048:Health Care Costs; D006801:Humans; D009720:Nurse Clinicians / Q000191:economics / Q000592:standards*; D010289:Parenteral Nutrition, Total / Q000191:economics / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D011787:Quality of Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control