CENTRAL LINE-ASSOCIATED BLOOD STREAM INFECTIONS (CLABSI)

BY: HILLARY, ROSE, SEAN, MARIE

SUMMARY
WHAT IS CLABSI? A CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION (CLABSI) OCCURS WHEN BACTERIA ENTERS THE BLOODSTREAM THROUGH A CENTRAL LINE CATHETER. IF BACTERIA START TO GROW ON THE CENTRAL LINE CATHETER, THEY CAN EASILY ENTER THE BLOOD AND CAUSE A SERIOUS INFECTION. THIS CAN LEAD TO A CONDITION CALLED SEPSIS, WHICH OCCURS WHEN BACTERIA OVERWHELM THE BODY. CAUSES - BACTERIA NORMALLY LIVE ON THE SKIN. THESE BACTERIA WILL SOMETIMES TRACK ALONG THE OUTSIDE OF THE CATHETER. FROM THE CATHETER, THEY CAN GET INTO THE BLOODSTREAM. SYMPTOMS - FEVER; CHILLS; INCREASED HR; REDNESS, SWELLING, OR TENDERNESS AT THE CATHETER SITE; DRAINAGE FROM CATHETER SITE RISK FACTORS: HAVING A CATHETER FOR A LONG TIME HAVING A CATHETER THAT IS NOT COATED WITH AN ANTIMICROBIALA SUBSTANCE THAT KILLS BACTERIA HAVING A CATHETER INSERTED INTO A VEIN IN THE THIGH HAVING A WEAKENED IMMUNE SYSTEM BEING IN THE INTENSIVE CARE UNIT HAVING AN INFECTION ELSEWHERE IN THE BODY OR SKIN TREATMENT OPTIONS:

ANTIBIOTICSTYPE DEPENDS ON WHICH BACTERIA IS FOUND IN YOUR BLOOD.

CENTRAL LINE CAREOFTEN, THE CENTRAL LINE CATHETER WILL NEED TO BE REMOVED AND REPLACED BY A NEW CATHETER

SUMMARY (CONT)
PROCESSES OF THE ISSUE KEY PLAYERS INVOLVED IN THE PROCESS
DOCTOR/IV TEAM REGISTERED NURSE CERTIFIED NURSING ASSISTANT/UAP PATIENT

CENTRAL LINE INSERTION

CARE OF CENTRAL LINE AFTER PLACEMENT

REMOVAL OF CENTRAL LINE

COMPARISON TO NATIONAL INDICATORS

CLABSI INCIDENCE STATISTICS: 250,000 CASES PER YEAR HERE ARE SOME NATIONAL ESTIMATES RELATED TO CLABSI:
15 MILLION CENTRAL-VASCULAR-CATHETER DAYS IN INTENSIVE CARE UNITS NATIONALLY 250,000 CLABSI CASES IN HOSPITALS, OF WHICH 80,000 OCCUR IN THE ICU 58 PERCENT DECREASE IN CLABSIS IN ICU PATIENTS COMPARING 2001 AND 2009 3,000 TO 6,000 LIVES SAVED IN 2009 COMPARED TO 2001 DUE TO THIS DECREASE $414 MILLION MEDICAL COST SAVINGS IN 2009 COMPARED TO 2001 DUE TO THIS DECREASE
SOURCE: BLOODSTREAM INFECTIONS: HOSPITALS MAY BE WINNING THE FIGHT, BUT THERES MORE WORK TO DO. THE JOURNAL OF HEALTHCARE C ONTRACTING;9(4):48, 50-53, 56, AUG. 2012. CLICK HERE TO LINK TO PUBLISHERS WEBSITE: HTTP://WWW.JHCONLINE.COM/BLOODSTREAM-INFECTIONS.HTML POSTED BY AHA RESOURCE CENTER, (312) 422-2050, RC@AHA.ORG

TO PREVENT OR REDUCE THE RISK

Hand Hygiene Barrier Precaution Do not use artificial nail when working in the healthcare Keep all supplies together on nursing unit to prevent facility. need to look for additional supplies after CVC Decontaminate hands with alcohol-based hand cleaner; insertion is begun. if hands are visibly contaminated with blood or body Use maximum barrier precautions when inserting or fluids, use antimicrobial soap and water. assisting with insertion of central venous catheters, Use hospital-provided hand lotions compatible with including PICC lines. Include: cap that covers all hair, antiseptic agents to maintain integrity of skin. Home mask covering mouth and nose, sterile gown, and lotions may neutralize antibacterial agents in antiseptic sterile gloves. agents used in hospitals. Cover client from head to toe with large sterile drape Decontaminate hands before and after putting on or leaving small opening for opening for insertion of removing gloves, providing direct client care, assisting catheter. with insertion of central venous catheter, changing Place mask on client when PICC insertion is done, central venous dressing, or accessing catheter to and cover face if subclavian or jugular vein administer medication or flush. placement site for central venous catheters. Daily Assessment Evaluate need to determine when lines are no longer necessary and should be removed. Provide site care when needed and according to facility policy.
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TO PREVENT OR REDUCE THE RISK (CONTD)

Catheter Site Selection Use central venous catheters (CVCs) impregnated with antimicrobial agents, if available. Nontunneled percutaneously inserted CVCs are available with three different agents; chlorhexidine/silver sulfadiazing; rifampin/minocycline; and silver/platinum ionic metals. PICC brand uses rifampin/minocycline agents. Catheter should be inserted in the subclavian vein for nontunneled catheter. These catheters should be used for clients with dwell time of more than 5 days and in healthcare facilities where catheter-related bloodstream infection rates are high. Site Preparation Using Chlorhexidine Gluconate Prepare site using 2% Chlorhexidine Gluconate Pinch wings on chlorhexidine applicator to break open ampule. Hold applicator down to allow solution to saturate pad. Press sponge against skin. Swab with applicator using a vigorous back-andforth motion. This motion creates friction and lets solution more effectively penetrate epidermal layers. Swab site for 30 seconds and then allow to dry thoroughly, approximately 2 minutes. Do not wipe or blot area.

EVIDENCED BASED RESOURCES

CLABSI Prevention in the Aloha State This article briefly talks about the control measures and tools that hospitals in Hawaii have used between 2009 and 2012 and greatly reduced their infection rates. This also included a link to a helpful video titled The Dirty Dozen (http://ow.ly/m66WB) which was created in 2012 by the Hawaii CUSP-STOP BSI collaborative to compare and contrast the techniques that help prevent CLABSIs vs. those that leave a patient prone to CLABSIs.
Source: CLABSI prevention in the Aloha state. (2013). Hospital Infection Control & Prevention, 404.

Reduction in Central Line-Associated Bloodstream Infections by Implementation of a Postinsertion Care Bundle This research article discusses how a central line care bundle (which includes steps from our QI tools) helps to drastically reduce the incidences of CLABSIs.
Source: Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. American Journal Of Infection Control, 38(6), 430-433. doi:10.1016/j.ajic.2010.03.007

Central Line Infections Fall in ICUs This article explains how there has been a 60 % decrease in CLABSIs between 2001 and 2009 by implementing preventive measures, which includes, but isnt limited to, our QI tools.
Source: Traynor, K. (2011). Central line infections fall in ICUs. American Journal Of Health-System Pharmacy, 68(8), 650-652. doi:10.2146/news110023

QI TOOLS & HOW TO EVALUATE

SURVEILLANCE THROUGH PROPER DOCUMENTATION (WRITTEN/ELECTRONIC)

REPORT INCIDENTS ACCORDINGLY

DATE & TIME, PROCEDURE (FLUIDS, MEDS), TOLERATION NOTE SIGNIFICANT CHANGES - S/S OF INFECTION (FEVER, CHILLS, REDNESS AND PAIN AT SITE, POSITIVE BLOOD CULTURE) REPORT ADHERENCE TO PREVENTATIVE MEASURE PUBLIC REPORTING (EXAMPLE ON LEFT)

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The Joint Commission. Preventing Central LineAssociated Bloodstream Infections: Useful Tools, An International Perspective. Nov 20, 2013. Accessed [user please fill in access date]. http://www.jointcommission.org/CLABSIToolkit

Q&A
What is CLABSI? Name 3 symptoms that might appear with CLABSI What is the treatment option? Aside from hand washing, name another way of protecting the patient when dealing with a Central line.

RESOURCES
Bloodstream infections: Hospitals may be winning the flight, but theres more work to do. The Journal of Healthcare Contracting;9(4):48, 50-53, 56, AUG. 2012. Http: //www.jhcoonline.com/bloodstream-infections.html. Posted by AHA Resouce Center, (312) 4222050, RC@AHA.ORG CLABSI prevention in the Aloha state. (2013). Hospital Infection Control & Prevention, 404.
Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. American Journal Of Infection Control, 38(6), 430-433. doi:10.1016/j.ajic.2010.03.007 The Joint Commission. Preventing Central LineAssociated Bloodstream Infections: Useful Tools, An International Perspective. Nov 20, 2013. Accessed [user please fill in access date]. http://www.jointcommission.org/CLABSIToolkit Traynor, K. (2011). Central line infections fall in ICUs. American Journal Of Health-System Pharmacy, 68(8), 650-652. doi:10.2146/news110023

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