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On the CUSP: STOP BSI Evidence for Best Practices for Placement and Maintenance of Central Lines

On the CUSP: STOP BSI Evidence for Best Practices for Placement and Maintenance of Central Lines. Learning Objectives. Review evidence for the 5 key best practices for CLABSI prevention Remove unnecessary lines Hand hygiene Use of maximal barrier precautions

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On the CUSP: STOP BSI Evidence for Best Practices for Placement and Maintenance of Central Lines

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  1. On the CUSP: STOP BSI Evidence for Best Practices for Placement and Maintenance of Central Lines

  2. Learning Objectives • Review evidence for the 5 key best practices for CLABSI prevention • Remove unnecessary lines • Hand hygiene • Use of maximal barrier precautions • Chlorhexidine for skin antisepsis • Avoid femoral lines • Review approaches for central line site care MMWR. 2002;51:RR-10

  3. Hand Hygiene: The Evidence Since 1977, 7 prospective studies have shown that improvement in hand hygiene significantly decreases a variety of infectious complications Clin Infect Dis 1999;29:1287-94 Lancet 2000;356:1307-1312

  4. What are Maximal Barrier Precautions? • For Provider: • Hand hygiene • Non-sterile cap and mask • All hair should be under cap • Mask should cover nose and mouth tightly • Sterile gown and gloves • For the Patient • Cover patient’s head and body with a large sterile drape

  5. Maximal Barrier Precautions

  6. Maximal Barrier Precautions: The Evidence Am J Med 1991;91(3B):197S-205S Infect Control Hosp Epidemiol 1994;15:231-8 Infect Control Hosp Epidemiol 2008; 29:947-950

  7. Skin Prep: Chlorhexidine Ann Intern Med. 2002;136:792-801

  8. What Site is Best? • RCT of femoral (N = 145) and subclavian (N = 144) lines in the ICU • Outcomes • Higher rate of infectious complications in femoral group: 19.8% vs. 4.5% (p < .001) • Higher rate of thrombotic complications in femoral group: 21.5% vs. 1.9% (p < .001); complete thrombosis 6% vs 0% • Similar rates of mechanical complications: 17.3% vs 18.8% (p = NS) JAMA 2001;286:700-7

  9. Strategies for Prevention: 5 Key “Best Practices” • Remove unnecessary lines • Hand hygiene • Use of maximal barrier precautions • Chlorhexidine for skin antisepsis • Avoid femoral lines MMWR. 2002;51:RR-10

  10. Catheter Site and Hub Care • Clean catheter hubs & injection ports with 70% alcohol or chlorhexidine/alcohol before accessing • Change transparent dressings and perform site care with chlorhexidine • Routinely every 5-7 days • If the dressing is loose, soiled or damp • Replace administration sets not used for blood products or lipids at least every 96 hours Infect Control Hosp Epidemiol 2008;29:S22-30

  11. Action Items • Assess compliance with best practices for catheter insertion • Assess compliance with best practices for catheter site care • Address solutions for barriers to best practice

  12. References • Guidelines for the Prevention of Intravascular Catheter-Related Infections; August 2002. • www.journals.uchicago.edu/doi/abs/10.1086/344188 • Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals; October 2008. • www.journals.uchicago.edu/doi/pdf/10.1086/591059

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