Central Line Associated BloodStream Infections

(CLABSIs)

By: Richel Grace T. Baldoza

Central Line-Associated Bloodstream Infection

• Infection can occur when bacteria grow in the line and spread into the bloodstream.

• is a primary blood stream infection (BSI) in a patient that had a central line within the 48 hour period before the development of the BSI

• If BSI develops in a patient within 48 hours of discharge from a location, attribute the CLABSI to the discharging location.

Central Line-Associated Bloodstream Infection

• Signs or symptoms: temperature above normal, fever, chills, or the skin around the central venous catheter (CVC) is painful, red, swollen or oozing,

CRITERIA 2Patient has at least one of the

following signs or symptoms: fever (>38ºC), chills, or hypotension

Central line associatedbloodstream infection

CRITERIA 1Patient has a recognized

pathogen cultured from one or more blood cultures

Organism culturedfrom blood is not

related to an infection at another site.

Common skin contaminant is cultured from two or

more blood cultures drawn on separate occasions

Signs and symptoms andpositive laboratory results

are not related to aninfection at another site

NOCentral line associatedbloodstream infection

Yes

No

Yes

Yes

Yes

No

No

No

No

Yes

Laboratory Confirmed Bloodstream Infection

Central Line or Central Venous Catheter

• A vascular infusion device that terminates at or close to the heart or in one of the great vessels and is used for infusion, withdrawal of blood, or hemodynamic monitoring.

The following are considered great vessels for the purpose of reporting central line associated

infections and counting central line days

• Aorta• Pulmonary artery• Superior vena cava• Inferior vena cava• Umbilical artery and

vein for neonates

• Brachiocephalic veins• Internal jugular veins• Subclavein veins• External iliac veins• Common femoral

veins

Modifiable Risk FactorsCharacteristic Greater Risk Lower RiskInsertion sercumstances

Emergency elective

Skill of inserter General specializedInsertion site 70% alcohol

10% povidone-iodine

2% chlorhexidine

Catheter lumens Multilumen single lumenDuration of catheter use

Longer duration of use greater risk

Barrier precautions Submaximal maximal

Central Line Care

A. Dressing:

1. All dressing shall be changed using sterile technique.

2. Initial dressing should be left in place for 24hrs unless heavy soild.

3. Gauze dressing should be changed daily for seven (7) days following insertion, then every forty eight (48) hour if no signs of infection or if the dressing becomes loose, wet or soiled.

B.Frequency of Flushing

1. A physician’s order is required to flushed with heparin 10 u/ml.

3. Flushed twice a day, if no IV fluids infusing or treatment.

2. Flush before and after every use of antibiotics blood products utilize SASH technique.

S- Flush the device with 10 ml 0.9% sterile salineA- administer the medication/ drw blood workS- Flush the device with 10ml 0.9% sterile salineH- Flush the device with 2ml heparin (10 u/ ml)

F. Change all injection ports every three days.

C. The catheter is to be looped and anchored with taped.

D. Required to keep vein open

E. Not required to swab for culture and sensitivity from central line insertion site that appears infected, however the physician must be notified that the site looks infected

To prevent catheter-associated bloodstream infections doctors and nurses will:

• Choose a vein where the catheter can be safely inserted and where the risk for infection is small.

Subclavian Vein First Choice

• Clean their hands with soap and water or an alcohol-based hand rub before putting in the catheter.

• Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it sterile. The patient will be covered with a sterile sheet.

• Clean their hands, wear gloves, and clean the catheter opening with an antiseptic solution before using the catheter to draw blood or give medications. Healthcare providers also clean their hands and wear gloves when changing the bandage that covers the area where the catheter enters the skin.

• Clean the patient’s skin with an antiseptic cleanser before putting in the catheter.

• Decide every day if the patient still needs to have the catheter. The catheter will be removed as soon as it is no longer needed.

Carefully handle medications and fluids that are given through the catheter.

Some patients are sent home from the hospital with a catheter in order to continue their treatment.

• Make sure you understand how to care for the catheter before leaving the hospital. For example, ask for instructions on showering or bathing with the catheter and how to change the catheter dressing.

• Make sure you know who to contact if you have questions or problems after you get home.

Some patients are sent home from the hospital with a catheter in order to continue their treatment.

• Make sure you wash your hands with soap and water or an alcohol-based hand rub before handling your catheter.

• Watch for the signs and symptoms of catheter-associated bloodstream infection, such as soreness or redness at the catheter site or fever, and call your healthcare provider immediately if any occur.

• Watch for the signs and symptoms

Personal Protective Equipment

(PPE)

Purpose

Refers to protective clothing, helmets, goggles,

or other garment or equipment designed to

protect the worker’s body from injury by blunt

impacts, electrical hazards, heat, chemicals and

infection, for job-related occupational safety and

health purposes

Personal Protective Equipment ( PPE)

Designed to protect the skin and mucuos membranes of the

eyes, nose and mouth from exposure to

blood or other potentially infectious

material.

How to Don a PPE

How to Don a PPE