Preventing Central Line-Associated Bloodstream

Infection (CLABSI) at Community Medical

Center

Background250,000 Central Veneous Catheter (CVC)

related blood stream infections occur in the United States each year, with a mortality of 12% to 25% per infection

30,000 to 48,000 patients die each year as a result of CLABSI’s-That’s 248 plane crashes a year

Each CLABSI cost an average of $3,700 to $25,000

Increasing the length of hospital stay by an average of 7 days.

Background continued

For 2008 CMC had 9 central line infections.

That is 9 to manyDo you want one of your family

members to be one of those 9?

Risk FactorsProlonged hospitalization before

catheterizationProlonged duration of the catheterizationInternal jugular catheterizationFemoral catheterizationEnvironment: Bacteria lives on walls, floors,

side bed rails…Microbial colonization at insertion siteMicrobial colonization of the

catheter hub

CMC is raising the barNationwide efforts are trying to reduce

preventable deaths in hospitals and CMC is in the fore front of this initiation

One of the ways identified to help reduce central line associated bloodstream infections (CLABSI) is by “Bundling” our central line procedure.

Bundling is taking 3-5 evidenced based practices or precautionary steps and put them together and implementing them together

When all of the practices/precautionary steps are done together the results equal improved quality patient care

Central line BundlingThe Central Line Safety Checklist & The

Central Line Maintenance Sheet is attached to the central line insertion kitUse it for central line insertion and

maintenance Fax both sheets after insertion to Infection

Control @ 329-4575, then turn it in to your manager

Hand HygieneWash hands before donning on gloves and after

procedure

Central line bundle continuedMaximal Barrier Precautions

New Central Line Supplement kit will be used in addition to the central line insertion kit

It will include sterile: cap (2), gown (2), mask (2), medication labels, Chlorhexidine swab (1), central line SorbaView Securement dressing (1), and a Biopatch (1)

Cover patient head to toe with the fenestrated section at the insertion site The subclavian is the optimal insertion site (femoral and jugular

is not recommended by CDC, it increases the risk of infection.) Physician and assistant: Wear cap, gown, sterile gloves and

mask.After insertion:

Place Biopatch at insertion site, then secure with the SorbaView Securement dressing

Do not suture central line in patient It increases patient discomfort and increase risk for infection

Chlorhexidine The formulation of 2% CHG and 70% Isopropyl alcohol. They

work together to provide the most rapid and persistent antimicrobial activity on the skin surface and acts fast on a broad spectrum of bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), and keeps fighting bacteria for at least 48 hours. It supports infection control guidelines for helping to reduce the incidence of blood stream infections

To usePinch the wings on the swab and releaseGently press the sponge against the treatment areaApply friction rub for 30 seconds on the upper torso and allow

to dry for 30 secondsFor lower torso rub for 2 minutes and allow to dry for 1 minute

Important ReminderDo not use on pediatrics weighing less than 1000 grams and

do not use on pediatrics who do not have good skin integrity

Biopatch Benefits:

Broad Spectrum antimicrobial and antifungal agentContinually releases chlorhexidine gluconate for 7 daysAbsorbs up to 8 times it’s own weightBIOPATCH is proven to reduce CLABSI’s by 60% in patients with

central venous catheters

Precautions:Do not use on pediatrics weighing less than 1000 grams and do

not use on pediatrics who do not have good skin integrityDo not place on infected wounds. It is not intended to be

used as a treatment of percutaneous infectionsImportant points to remember:

PLACE SHINY SIDE UPTo be used on all central line insertions and changed when

dressing change occurs (EVERY 7 DAYS)

Securement DressingDo not suture central line into patient as

this :Increases patient discomfortIncreases risk for infectionSuturing increases risk of needle stickChange Securement dressing every 7 days(use

central line dressing change kit)

Daily Review of Central lineDocument on Central line flowsheet

Central line insertion dateDaily assessment of insertion site (each shift)Evaluate all central lines daily with physician

and remove nonessential lines

We are all an essential piece in preventing infections.Help out patients get the best quality care here at CMC and be a role model to other hospitals References:

CDC, 1000 Lives CampaignInstitute for Healthcare Improvement: Implement the Central Line /IHI/Topics/Critical Care/intensive Care/Changes, last accessed 4/09Society of Healthcare Epidemiology of America , Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals 2008http://www.medicinenet.com/mrsa_picture_slideshow/article.htm, Last accessed 4/09PP by Scappel 09

ReferencesCDC, 1000 Lives CampaignInstitute for Healthcare Improvement: Implement

the Central Line http://www/IHI/Topics/Critical Care/intensive Care/Changes last accessed 4/09

Society of Healthcare Epidemiology of America , Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals 2008

hhtp://www.medicinenet.com/mrsapicture_slideshow/article.htm Last accessed 4/09

PP by Scappel/Jshaw 09