novant prevention of central line associated bloodstream infection 10-12-09

8/13/2019 Novant Prevention of Central Line Associated Bloodstream Infection 10-12-09

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DirectionsRead module.

Complete test at the end of the module.Sign roster for proof of completion.

Instructors return completed roster only.

Return via fax to: Miranda Ingram (7!" #$%&'#

Student )rograms Coordinator* +CM


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)R,-,/I0 01

C,/R23 3I,&2SS0CI2/,D4300DS/R,2M I1,C/I0S(C324SI"

Corporate C324SI )revention /eam

/arget 2udience: 2ll healthcare 5or6ers inserting or managing centrallines.


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Course NavigationCourse Navigation

2dvance through the course using thenavigation ar on the ottom of the screen.

8 ust clic6 the for5ard utton (shown below)


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09ectives

no5 the definition of a central line catheter

Identif; the classifications and t;pes of central line catheters

Discuss ris6 factors and sources of central line associated

loodstream infections (C324SI"


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/erms

4SI = loodstream infection CDC > Centers for Disease Control ?

,pidemiolog; C@+ = chlorhexidine C-C > central venous catheter C324SI > central line associated

loodstream infection


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+eneral Information

48% of ICU patients have central venous catheters(CVCs),accounting for $A million C-C&da;s per ;ear inIC


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@o5 do central lines causeloodstream infectionsG

Central venous catheters (C-Cs" disruptthe integrit; of the s6in allo5ing acteriaandHor fungi to enter.

Infection can spread to the loodstream(acteremia"

@emod;namic changes and organd;sfunction (sepsis" ma; ensue.


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C324SI Definition

2 C324SI is a primar; loodstream infection (4SI"in a patient that had a central line within the !'&hourperiod efore the development of the 4SI.

1or the Infection )reventionist to classif; a C324SI*nationall; accepted criteria from the CDC should e

met.


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Ehat is a central lineG

2n intravascular catheter that terminates at or close to theheart orin one of the great vessels. /his line is used for infusion*5ithdra5alof lood* or hemod;namic monitoring.

+reat -essels include: 2orta Superior vena cava Inferior vena cava 4rachiocephalic vein Internal 9ugular vein Suclavian vein )ulmonar; arter; ,xternal iliac vein Common femoral vein In Neonates count*


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/he follo5ing classif; as Central3ines

(ma; not e all inclusive". . .

Suclavian* 1emoral or Internal 8 ugular (single*doule* triple or uad"

Introducer JCordisK S5an +anL catheter )ICC @emodial;sis -as&Caths (tunneled and non&

tunneled" Implanted ports (i.e.* )ort&a&caths"


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Sources of C324SIs

Migration of s6in organisms at the insertion siteinto the cutaneous catheter tract 5ithcoloniLation of the catheter tip is the mostcommon route of infection.

Contamination of the catheter hu alsocontriutes to intraluminal coloniLation of long&

term catheters.

Rarel;* contamination of the infused fluid leadsto infection.


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)athogenesis


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Clinical 1eatures of 3ineSepsis

Nonspecific 1ever Chills* sha6ing rigor

@;potension* shoc6 @;perventilation +astrointestinal

adominal pain -omiting

Diarrhea eurologic

confusion seiLures

Highly Suggestive of LineSepsis Source of sepsis unapparent )atient unli6el; candidate for

sepsis Intravascular line in place (or

recentl; in place" Inflammation or purulence at

site 2rupt onset* 5ith shoc6 Sepsis response to

antimicroial therap; ordramatic improvement after

removal of device


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Ehat can 5e do to prevent aC324SIG

atient!a&ily '#ucationrior to Central ine Insertion

,nsure the patient (and famil; as needed" areeducated aout central line infection preventionprior to the procedure eing performed.

Document the education on the patients medical

record. )atient education fl;er can e otained ; goingto the ovant @ealth Intranet )2/I,/ ,D


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Central 3ine 4undleCompliance

/he central line undle is a group of evi#ence ase# interventionsforpatients 5ith intravascular central catheters that* 5hen implementedtogether* result in etter outcomes than 5hen implementedindividuall;.

/he science ehind the undle is so 5ell estalished that it should e

considered standard of care.

e; Components:$. hand h;giene. maximal arrier precautions (oth for the patient and the inserter"

5hen placing a central line#. chlorhexidine s6in antisepsis!. optimal catheter site selection (suclavian preferred site"A. dail; assessment of line necessit; 5ith prompt removal of

unnecessar; line


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)rior to InsertionDemand Strict @and @;giene

0serve proper hand 5ashing procedures either 5ithconventional antiseptic&containing soap and 5ater or

5ith alcohol&ased hand ru.


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Insertion:

Head cover

Mask

Sterile Gown

Sterile Gloves

/he personinserting ? those

assistingshould donmaximal arrier

precautions.


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Maximal )atient 4arrier:

Drape the patient with the full body drape (head-to-toe).


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Maintain a Sterile 1ieldDuring the Insertion:

I i


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Insertion:/he person inserting the central lineshould:


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Chlorhexidine 2lert . . .

Chlorhe;i#ine shoul# not e use# on< Infants less than months of age

(unless approved by your facility)

or 2n;one 5ith a chlorhexidine sensitivit; orallerg;. 1or those meeting the aove alerts* $ povidone&

iodine or 7 alcohol ma; e used as an alternatives6in prep.

If inserting an umilical central line* avoid tincture ofiodine ecause of the potential effect on the neonatalth;roid. 0ther iodine&containing products (e.g.*povidone&iodine" can e used.


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2fter Initial Insertion

2ppl; occlusive sterile dressing per ;ourfacilit;s polic;.


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ocumen a on on e un eCompliance /ool

The ! or personnel assistin"

the physician # inserter with the

procedure will co$plete the

Central Line Procedural

Checklist(either electronically

or $anually% dependin" on the

availability at your facility).

Central Line Procedural Checklist

Insertion Date: ____/____/____ Time: _________ Unit Location Where Inserted: _____________

Inserter Name: Last:_______________________ First:_________________

Patient education given rior to insertion!

Line insertion "as #check one$: %mergent Non&emergent

Central line catheter t'e: Non&tunneled Central (enous Catheter #i!e!) Trile Lumen$Tunneled Central (enous Catheter #i!e!) *ickman) +roviac) Neostar) ,roshong$PICC*emodial'sis #circle one$: tunneled non&tunneledIntroducer / CordisImlanta-le orts #i!e) Port&a&cath$."an,anUm-ilical

Num-er o0 lumens #circle one$: 1 2 3 4 Not alica-le

.ite o0 C(C Insertion: .u-clavian 5ugular Femoral Um-ilical Uer e6tremit'

I0 0emoral site used) state reason: ______________________________________________________________

Before the procedure,did the inserter: Per0orm hand hygiene 7es No Drae atient "ith large full body drape 7es No Pre the site "ith CHG8 7es No

I0 no or contraindicated) state reason: _____________________________________________________

During the procedure,did the inserter use: Sterile gloves 7es No Sterile gown 7es No Head cover 7es No Mask 7es No

Did all personnel assisting*"ith the rocedure use: Sterile gloves 7es No Sterile gown 7es No Head cover 7es No Mask 7es No

#9ssisting an'one lacing hands on the atient "hile the sterile 0ull -od' drae is on the atient oran'one handing sterile sulies to the inserter!$

.ignature o0 erson comleting 0orm:_______________________________ Date:___________________

PATIENT Label!"#!$ H%&$H

Central &ine 'rocedural Checklist


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3ine ecessit;

Dail; revie5 of central line necessit;ma; preventdela;s in removing lines that are no longer needed.

Man; times* central lines remain in place simpl;ecause of their reliale access and ecausepersonnel have not considered removing the line.

@o5ever* it is clear that the ris6 of infection increasesover time as the line remains in place and that the ris6of infection is decreased if removed.


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Dail; Revie5 of 3ineecessit;

,ver; da;* as6 the follo5ing: Does the patient still need the lineG

If yes,can a less ris6; catheter e usedG (e.g.* triple lumen to a peripheral"G If no* can 5e remove the line toda;G

* central line &ay e consi#ere# necessary for the follo9in7: long&term antiiotics* multiple I- antiiotics* multiple lood H lood products* vesicant drugs (Dopamine* Dilantin* -ancom;cin" or irritant drugs

(Cefoxitin* 1ortaL"* /)* chemotherap;* hemod;namic monitoring* reliale access (I- fluid therap;* freuent lood dra5s* pain management".


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Dail; Revie5 of 3ineecessit;

C%!$(& &)!% !%C%SS)$ + D)& (%#)%-Goal- $o reduce central line associated infections and other co.plications

Insertion Unit Location#s$: _____________

To -e comleted -' ;N caring 0or the atient dail' 0or as long as the line is in lace!;evie" line necessit' dail' and check aroriate -o6!

central line .ay be considered necessary for the following: #1$ long&term anti-iotics) #2$ multile I(anti-iotics) #3$ multile -lood / -lood roducts) #4$ vesicant drugs #Doamine) Dilantin) (ancom'cin$ or irritant drugs#Ce0o6itin) Forta$) #


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Dressing Changes

Replace catheter&site dressing if it ecomesdamp* loosened* or visil; soiled or 5heninspection of the site is necessar;.

Dressing changes are to e done ased on ;ourfacilit;s polic; and line t;pe.

Chlorhexidine is the preferred cleansing agent.Ehen cleansing the dressing site* use

chlorhexidine (C@+" s5a or other approvedagents per ;our facilit;s polic;.


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Dressing Changes (continued"

Do not use topical antiiotic ointment or creamson insertion sites (except dial;sis catheters".

Do not sumerge the catheters under 5ater. -isuall; inspect site for s5elling* er;thema or

drainage. If an; of these s;mptoms are presentnotif; ph;sician.

Do not use acetone or adhesive remover toremove old dressings./ransparent dressing material 5ill release 5hen

stretched.


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2dministration Sets

Replace administration sets* including secondar; sets ?add&on devices* no more freuentl; than at 7&hourintervals* unless C324SI is suspected or documented.

,xception: 2dministration sets that have eenintermittentl; disconnected from the patient (opens;stem" shall e changed ever; ! hours andimmediatel; upon suspected contamination or 5henthe integrit; of the product or s;stem has een

compromised.

Replace tuing used to give loodHlood products aftereach unit of loodHlood product is given.


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)rovide optimal care forI- In9ection )orts

)rior to accessing the port* clean itper the manufacturers guidelines

(:0 t9ists 9ith "0% alcohol" andallo5 to air dr; efore accessing thes;stem. (o lo5ing or fanning".

Cap all central line ports 5hen not inuse.

Change caps no more freuentl; thanever; 7 hours and at least ever; 7

da;s or according to themanufacturers recommendations.

'>C'+I/< Chan7e the cap 9hen: it has een removed for an; reason or an;time the cap appears damaged* is lea6ing* lood is seen in the catheter 5ithoutexplanation* lood residue in the cap or 5hen cap has een laid do5n on a non&

sterile surface.


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@emodial;sis Catheters

Do not use hemodial;sis catheters for lood dra5ing orapplications other than hemodial;sis except duringdial;sis* under emergenc; circumstances or 5ith MDorder.


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References

http:HH555.cdc.govHnhsnH)D1sHpscManualH!)SCNC324Scurrent.pdf

http:HH555.ihi.orgHI@IH)rogramsHCampaignHCe

ntral3ineInfection.htm CDC. +uidelines for the prevention of

intravascular catheter&related infections.MMER FA$(o. RR&$"


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You have now completedYou have now completedPrevention of CLABSIPrevention of CLABSI

CON!AT"LATIONS#CON!AT"LATIONS#

Please continue to the test instructions on the next slide


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$ow to !eceive Credit

To receive credit for thi% module &ou mu%t complete the te%t' To

complete the te%t( clic) the Ta)e Te%tlin) in the menu on the left

%ide of the %creen *pictured here+'

This will automatically launch the test.This will automatically launch the test.


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Post Test

1. The CDC estimates the attributable treatment costs associated with abloodstream infection range from $35,000 to $56,000/infection and increase length of

sta b an a!erage of " das. #Circle one)True or ,al%e'

. % C&%'() is a *rimar bloodstream infection #'()+ in a *atient that had a central

line within the -hour *eriod before the de!elo*ment of the '(). #Circle one)

True or ,al%e

3.% central line is an intra!ascular catheter that terminates at or close to the heart orin one of the smaller *eri*heral !essels. #Circle one)

True or ,al%e

.hich of the following classif as a central line

a' Subclavian( ,emoral or Internal -u.ular *%in.le( double( triple or /uad+

b' Introducer 0 Cordi%c' Swan an1 catheter

d' PICC

e' $emodial&%i% 2a%3Cath% *tunneled and non3tunneled+

f' Implanted Port% *i'e'( Port3a3cath%+

.' "mbilical *"2C+

h' All of the above


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Post test (Contd)5' (ources of central line infections are

a' 4i.ration of %)in or.ani%m% at the in%ertion %ite into the cutaneou% catheter tract'

b'Contamination of the catheter hub'

c' Contamination of the infu%ed fluid'd' All of the above

6' The central line bundle is a grou* of e!idence based inter!entions for *atients with

intra!ascular central catheters that, when im*lemented together, result in better outcomes than

when im*lemented indi!iduall. Circle one

True or ,al%e

".2e com*onents of the e!idence based central line insertion checlist includes

a' hand h&.iene

b' ma5imal barrier precaution% *both for the patient and the in%erter+ when placin. a central line

c' chlorhe5idine %)in anti%ep%i%

d' optimal catheter %ite %election *%ubclavian preferred %ite in an adult+

e' dail& a%%e%%ment of line nece%%it& with prompt removal of unnece%%ar& line

f' All of the above

-. 4rior to the insertion of the central line the *atient should be

a' Educated about the central line and how to prevent infection'

b' 6raped with a full bod& drape *head to toe+'

c' iven a pair of %terile .love%'

d' All of the above'e' A and B


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novant prevention of central line associated bloodstream infection 10-12-09

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