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Getting to zero?
Susan Bedwell DNP, MS, APRN, CCNS-N
I have nothing to disclose
IDSA CDC
• Isolation of same pathogen from central line
and peripheral source with higher CFU in
line
• Same organism in peripheral and catheter
tip with > 15 CFUs
• > 2 hr to positivity between central and
peripheral culture
• Positive blood culture in patient with central
line
• Positive culture within 48 hours of removal
• Not a common commensal or previous
infection
Reported rates range from 3.2 -21.8 CLABSIs/1000 line days.
# of CLABSIs
# of line days/1000
Lower line days, greater impact of a CLABSI
Bacteremia that occursFollowing insertion of a centrally-place line
While the catheter is indwelling
Within 48 hours of discontinuation
Cannot be attributed to any other source
CDC, (2018) Bloodstream Infection Event (Central Line-Associated
Bloodstream Infection and Non-central Line Associated Bloodstream Infection)
Bacteremia that occursFollowing insertion of a
centrally-place line
Terminates close to the heart
Terminates in one of the great vessels
From Robert and Hedge’s Clinical
Procedures in Emergency Medicine
Bacteremia that occursFollowing insertion of a
centrally-place line
Infusions
Blood draws
Monitoring
Bacteremia that occursFollowing insertion of a centrally-place line
While the catheter is indwelling
A positive blood culture regardless of site
https://creativecommons.org/licenses/by/4.0/)
Bacteremia that occursFollowing insertion of a centrally-place line
While the catheter is indwelling
Within 48 hours of discontinuation
Bacteremia that occursFollowing insertion of a centrally-place line
While the catheter is indwelling
Within 48 hours of discontinuation
Cannot be attributed to any other source
Not a contaminant
Not a UTI, PNEU, NEC
Increase mortality and morbidity
Affect CMS HAI IPPS
Increase health care costs$50,000 and 10 day increase to LOS
Care bundles work Meta-analysis 24 international studies
NICU level varied
Statistically significant reduction in CLABSIs
Widespread variation in bundled elements
Skin preparation and education most common components
(Payne, Hall, Prieto and Johnson, 2018)
Insertion
Maintenance
Prevention
Shed 10 million epithelial cells per day
HCW hands colonized with pathogens
Highest rates of cross-transmission from critical care areas
5 Moments for Hand Hygiene
Remove jewelry and chipped nail polish
https://creativecommons.org/licenses/by/4.0/)
(Pelligrino, Crandall, & Seo, 2016,
https://creativecommons.org/licenses/by/4.0/)
InsertionStrict handwashing
Skin antiseptic
Full sterile barrier precautions
Skilled, dedicated team
InsertionSkin antiseptic
CHG vs Povidone-iodine
CHG reported to cause burns on premature skin
Povidone-Iodine linked with thyroid function
(Rustogi, et al., 2005)
InsertionFull sterile barrier precautions
Gown, gloves, hat
Full patient barrier
Hat and mask within 3 feet
Prevent traffic
T. Doussette, 2018. Used with permission.
InsertionSkilled, dedicated team
Improves successful attempts
Decreases # of attempts
Standardizes care
Faster adoption of EBP
MaintenanceHand hygiene
Scrub the Hub
Sterile dressing change
Neutral or positive displacement cap
Sterile tubing change
MaintenanceScrub the Hub
15 second alcohol scrub
Alcohol impregnated caps
MaintenanceSterile dressing change
Hat, mask, gloves and field
2 person dressing changes
Checklist
MaintenanceNeutral or positive displacement cap
Follow manufacturers guidelines
MaintenanceSterile tubing change
Hat, gloves, mask
Sterile field for priming
Cap for end of fluids
PreventionHand hygiene
Environmental cleaning
Early line removal
PreventionEnvironmental cleaning
Daily disinfection of hard surfaces
Daily linen change
PreventionEarly line removal
> 95% compliance with bundles associated with decreased rates
Feeding protocols
Use of non-central lines
Rate versus Number
All late-onset are HAIs
Evidence of relationship to pulmonary and intra-abdominal pathologies
Prevalence of MDROs – Antibiotic Stewardship
• Good stewardship of
central line use
• Bundles improve CLABSI
rates
• Overall strategy for
infection prevention
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