Transcript Central Line Association Blood Stream Infection - 2014

ETMC
July 2014
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90% of all blood stream infections are associated with central
vascular access devices.
400,000 CLABSI’s occur per year in the US
CLABSI’s are:
1) Associated with increased morbidity
2) Associated with mortality rates of 10% - 20%.
3) Associated with prolonged hospitalization (mean of 7
days) and increase in medical costs $28,000 - $47,000.
Joint Commission – CLABSI Fact Sheet
1. CLABSIs result annually in*:
• 84,551-203,916 preventable infections.
• 10,426-25,145 preventable deaths.
• $1.7-21.4 billion avoidable costs.
2. The following interventions decrease the risk for CLABSIs:
• Appropriate hand hygiene,
• Use of chlorhexidine for skin preparation,
• Use of full-barrier precautions during central venous catheter insertion,
• Avoid using the femoral vein for central venous catheters in adult
patients, and
• Removing unnecessary central venous catheters.
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Umscheid, CA, et al. Estimating the proportion of reasonably preventable hospital-acquired
infections and associated mortality and costs.
A central venous access device, also called a central line, is a
long, thin, flexible tube used to give medicines, fluids, nutrients,
or blood products over a long period of time, usually several
weeks or more. A catheter is often inserted in the arm, neck or
chest through the skin into a large vein. The catheter is threaded
through this vein until it reaches a large vein near the heart.
The following are some examples of central venous access
devices used at ETMC.
Multi-Lumen Catheter
Implanted Port
Tunnel Catheter
PICC Line
Quinton Catheter
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Since 1977, at least 7 prospective studies have shown that
improvement in hand hygiene significantly decreases a variety
of infectious complications. Proper hand-hygiene procedures
can be achieved through the use of either a waterless, alcoholbased product or an antibacterial soap and water with adequate
rinsing. Compared with peripheral venous catheters, CVCs
carry a substantially greater risk for infection; therefore, the
level of barrier precautions needed to prevent infection during
insertion of CVCs should be more stringent than proper hand
hygiene alone.
Joint Commission – CLABSI Fact Sheet
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Use a catheter checklist to ensure
adherence to infection prevention
practices at the time of CVC insertion.
Maximal sterile barrier precautions (e.g.,
cap, mask, sterile gown, sterile gloves,
and large sterile drape) during the
insertion of CVCs substantially reduces
the incidence of CLABSI compared with
standard precautions (e.g., sterile gloves
and small drapes).
Joint Commission – CLABSI Fact Sheet
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Patient ID x 2
Announce the procedure to be
performed
Mark/access the site
Patient is positioned correctly
All required equipment is in the room
Medications/syringes are labeled
All involved are present and agree that
“TIME OUT” is correct
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Use an all-inclusive catheter kit.
Use full maximal sterile barrier precautions
during CVC Insertion.
A mask, cap, sterile gown, and sterile gloves
are to be worn by all healthcare personnel
involved in the catheter insertion procedure.
Kit contains protective wear for only one
person.
Anyone else in the room must wear a mask
and cap.
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In a study from 1991, preparation of central venous and
arterial sites with a 2% aqueous chlorhexidine gluconate
lowered BSI rates compared with site preparation with 10%
povidone-iodine or 70% alcohol. Since that time, there has
been growing evidence that chlorhexidine-containing skin
preparation is superior to other options. A meta-analysis from
2002 that pooled results of these studies demonstrated use of
a chlorhexidine-containing preparation decreased central
catheter related infections by 49% relative to povidone-iodine
preparations. Because a smaller effect of chlorhexidine was
seen in studies using a 0.5% concentration of chlorhexidine,
preparations with greater concentrations are recommended.
Joint Commission – CLABSI Fact Sheet
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Healthcare personnel should
be empowered to stop the
procedure if a breach in
aseptic technique are
observed
Preventing infections is our
#1 Goal
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The site at which a catheter is placed
influences the subsequent risk for catheterrelated infection and noninfectious
complications. For adults, lower extremity
insertion sites are associated with a higher
risk for infection than are upper extremity
sites. As a result, authorities recommend
that the femoral vein be avoided. Place
CVCs in an alternative site to reduce the
risk for infection. The risk of noninfectious
complications should be assessed on an
individual basis when determining which
site to place the CVC.
Joint Commission – CLABSI Fact Sheet
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Securement devices prevent the catheter from sliding in and out
from the insertion site. This plays an important role in infection
prevention and catheter daily placement.
Multi-lumen catheters are secured with sutures. Make sure not to
insert the central line past the double line. This space is needed
to place the antimicrobial disc. A StatLock can be used if the
sutures are loose or the physician orders it.
PICC lines are secured with a StatLock and must be replaced
weekly with the dressing change. Some of these lines are also
sutured into place per physician order.
Quinton catheters have a larger bore and requires a different
antimicrobial patch that has a larger round hole center. These
lines are also sutured in place
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Before accessing catheter
hubs/claves or injection ports,
clean them with an
chlorhexidine preparation or a
70% alcohol prep pad to
reduce contamination
Chlorhexidine containing
sponge dressing for CVC’s in
patients older than 2 months
of age
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All central line dressings will have the clear plastic film dressing.
All central line dressings will be changed every Friday and prn when the
dressing is compromised.
All central line blue claves will be changed every Friday and tubing will be
changed every Monday and Friday.
All central lines will be flushed q 8 hours with prefilled saline syringe.
All central lines will be flushed before and after medication administration and
lab draws with prefilled saline syringe.
All central line blue claves will be scrubbed with an alcohol prep pad each and
every time the line is accessed.
All central lines will have an antimicrobial disc to prevent infections. If the disc
is saturated with blood or fluid the dressing must be changed. Tell the nurse or
place an order to change the dressing.
All central line dressings will be dated when it was last changed.
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One of the most effective strategies for
preventing a CLABSI is to eliminate, or at least
reduce, exposure to central venous catheters.
The decision regarding the need for a catheter
however is complex and therefore difficult to
standardize into a practice guideline.
Nonetheless, to reduce exposure to central
venous catheters, the multidisciplinary team
should adopt a strategy to systematically
evaluate daily whether any catheters or tubes
can be removed.
Joint Commission – CLABSI Fact Sheet
Intrinsic Risk Factors
Extrinsic Risk Factors
(nonmodifiable characteristics of the patient)
(potentially modifiable factors associated with CVC
insertion or maintenance)
Patient age
Prolonged hospitalization before CVC insertion
Underlying diseases or condition
Multiple CVCs
Patient’s gender
Parenteral nutrition
Femoral or internal jugular access site
Heavy microbial colonization at insertion site
Multilumen CVCs
Lack of maximal sterile barriers for CVC insertion
CVC insertion in an ICU or emergency department
Joint Commission – CLABSI Fact Sheet
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Surveillance Definition (different from clinical)
Must have a central line in place for two calendar days.
Must have a recorded symptom like chills or hypotension
and/or a temperature greater than 100.4 the day before, day
of or the day after.
Must have one positive blood culture from a central line or
venipuncture or 2 common commensals drawn from 2 or
more blood cultures on separate occasions, no more than 1
day between.
Unable to link the pathogen to another site such as sputum,
wound or urine.
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Documenting a link between a central line and an
bloodstream infection will automatically code the entry
as a CLABSI (Central Line Associated Blood Stream Infection) even if
the criteria does not meet the surveillance definition
and criteria.
Document and interpret the organism found in the
blood stream as either bactremia, septicemia,
sepsis/SIR, or severe sepsis, contaminate, or
colonization. These terms will drive the specifics of
the coding.
East Texas Medical Center - Tyler
Completion Verification
for
Central Line Associated Blood Stream Infection (CLABSI) and Prevention
Education for Medical Staff and their Allie Health Providers (AHP)
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presentation titled "Central Line Associated Blood Stream Infection (CLABSI) and
Prevention Education for Medical Staff and their Allie Health Providers (AHP)" for CY 2014.
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