Preventing contamination at the time of central venous catheter insertion: A literature review and recommendations for clinical practice

Aims and objectives: To evaluate the evidence base and rationale underpinning the various infections control strategies during central venous catheter insertion and to promote discussion about the key, recurring concepts and recommendations in the literature. Logistical and organisational factors relating to central venous catheter insertion are also examined. Background: Catheter-related bloodstream infections following the insertion of central venous catheters are associated with significant patient mortality and morbidity, prolonged hospital stays and increased economic costs. Limited published literature specifically examines microbial contamination during the peri-insertion process. Methods: An integrative literature review supervised by a health informatics librarian was undertaken. On the basis of these data, considerations for clinical practice are provided. Retrieved articles were categorised under the following themes: risk of contamination at insertion; clinical and organisational impact of contamination; strategies for reducing contamination; controversies and challenges with decontamination strategies; recommendations for practice and implications for further research and organisational practice. Results: Specific recommendations for reducing catheter-related bloodstream infections based on recurring themes include the following: reducing microbial burden on skin prior to the central venous catheter insertion; decreasing contact of gloves and insertion equipment with the patient's skin; using specifically trained staff to prepare and maintain a sterile field; and ensuring a sterile technique is adhered to throughout the central venous catheter insertion process. The need for organisational, procedural and clinical practices to support better healthcare outcomes is demonstrated. Highlighting the importance of executive support and regular review of policy and guidelines are necessary to improve patient outcomes. Conclusions: Preventing infections related to central venous catheters requires the integration of clinical, organisational and workforce factors. © 2013 Blackwell Publishing Ltd

Australasian Coasts and Ports 2017 Conference

© Australasian Coasts and Ports 2017 Conference. All rights reserved. Management of coastal erosion caused by both natural and anthropogenic drivers is an ongoing challenge for many island nations of the Pacific. While conventional coastal protection techniques have included rock or concrete revetments and seawalls, non-conventional or 'non-engineered' protection methods have also been trialled with varying levels of success. Typically these alternative protection methods have looked to overcome obstacles to traditional forms of coastal protection such as a lack of suitable construction materials or high costs to import materials. The Pacific Region Infrastructure Facility is undertaking a study on affordable coastal protection options in the Pacific Islands. The first of three project stages developed a desktop analysis to catalogue and critically evaluate the range of coastal protection methods used throughout the Pacific Islands, and identified several more affordable alternative coastal protection methods with potential for use on low energy coastlines. These alternative methods included the use of smaller hand-placed sand-filled geotextile containers, as well as the use of concrete masonry "besser" construction blocks, both placed on a sloping revetment. These innovative protection options have the benefit of being either widely available or cheaper to import to Pacific Islands, and they can be placed without the need for heavy construction equipment. The second stage of the project comprised a physical modelling study to investigate the performance of these alternative coastal protection methods, and to develop a design guidance report. The results will be piloted in stage three to verify and monitor these alternative coastal protection measures in Pacific Islands over time. This paper presents results from the physical modelling stage of the project. The modelling program considered the stability and runup/overtopping characteristics of both 40kg sand-filled geotextile containers as well as concrete masonry blocks, placed on a 1V:1.5H revetment slope. A range of placement configurations and wave conditions were investigated for both armouring options to determine the threshold of unit stability. The results indicated that the geotextile containers could be used in wave conditions with significant wave height up to approximately 0.5 m, while the concrete masonry blocks were stable in waves with significant wave height up to 1 m

WHARVES AT THE EDGE OF THE WORLD: PHYSICAL MODELLING OF ZERO MAINTENANCE BREAKWATERS IN REMOTE LOCATIONS

During the design process for a breakwater, construction and maintenance considerations usually play a major part in determining the final geometry of the structure. This is particularly the case in remote locations with limited availability of materials, plant and machinery combined with the tyranny of distance. This paper presents the design development to upgrade existing wharves at two sites within, the Chatham Islands archipelago. These islands are populated by only 600 people, and the wharves on the two inhabited islands, Chatham and Pitt, provide a lifeline for their communities.The physical modelling of both wharves led to a significant reduction of design risks, and constructability improvements. Empirical techniques were found to have mixed results for estimating the stability of concrete primary armour (Xbloc® and Hanbar units) and rock toe armour. Secondary armour stability tests with the breakwater in an “under construction” state also provided insights for construction planning. On Pitt Island, wave overtopping processes were very three dimensional such that they could only be robustly estimated using the physical model. On the head of both wharves, it was necessary to extend the crown wall normal to the long axis of the breakwater to improve overtopping and armour stability on the leeward side