i have nothing to disclose

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



A positive blood culture regardless of site

https://creativecommons.org/licenses/by/4.0/)




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


(Pelligrino, Crandall, & Seo, 2016,


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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i have nothing to disclose

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