etmc july 2014
DESCRIPTION
Central Line Associated Blood Stream Infection (CLABSI) and Prevention Education for Medical Staff and their Allied Health Providers (AHP). ETMC July 2014. - PowerPoint PPT PresentationTRANSCRIPT
Central Line Associated Blood Stream Infection
(CLABSI) and Prevention
Education for Medical Staff and their Allied
Health Providers (AHP)
ETMCJuly 2014
The information in this self-pace education presentation is intended to re fresh and / or
bring new information to you regarding techniques to use to prevent Central Line
Associated Blood Stream Infections (CLABSI). Some pertain to hospital staff while others pertain to anyone involved in the care of a
patient.
National Patient Safety Goal (NPSG) 07.04.01 - Implement
evidence-based practices to prevent central line-associated bloodstream infections. Note: Involves short and long term central venous catheters and peripherally inserted central
catheter (PICC) lines.
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 morbidity2) 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
Statistics for CLABSI’s
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.
• Umscheid, CA, et al. Estimating the proportion of reasonably preventable hospital-acquired
infections and associated mortality and costs.
CLABSI Fact Sheet
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 PICC LineImplanted Port Quinton CatheterTunnel Catheter
What is a Central Line?
Hand Hygiene 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, alcohol-based 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
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
Insertion Checklist
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
Time Out (Universal Protocol)
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.
Catheter Insertion Kit
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
Chlorhexidine
Healthcare personnel should be empowered to stop the procedure if a breach in aseptic technique are observed
Preventing infections is our #1 Goal
Aseptic Technique
The site at which a catheter is placed influences the subsequent risk for catheter-related 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
Subclavian Vein
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
Securement Device
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
Hub/Clave
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.
Care of Central Lines
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
CVC Daily Rounds
Intrinsic Risk Factors(nonmodifiable characteristics of the
patient)
Extrinsic Risk Factors(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
Intrinsic and Extrinsic
Risk Factors for CLABSI
Joint Commission – CLABSI Fact Sheet
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.
CLABSI Criteria
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.
Documentation
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) I _____________________________________ certify that I have reviewed the power
point presentation titled "Central Line Associated Blood Stream Infection (CLABSI) and Prevention Education for Medical Staff and their Allie Health Providers (AHP)" for CY 2014.
Signature and Title: ____________________________
Date_______________