slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION PowerPoint Presentation
Download Presentation
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION

Loading in 2 Seconds...

play fullscreen
1 / 13

CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION - PowerPoint PPT Presentation


  • 96 Views
  • Uploaded on

CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION. The Central Line Bundle and YOU! 6/6/2013 Quality Assurance/Peer Review Report Privileged Pursuant to O.R.C. Section 2305.24, .251, .252. NATIONAL PATIENT SAFETY GOAL 2009. 2009 National Patient Safety Goal or (NPSG.07.04.01) requires:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION' - oliver-nichols


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION

The Central Line Bundle and YOU!

6/6/2013

Quality Assurance/Peer Review Report

Privileged Pursuant to O.R.C. Section 2305.24, .251, .252

national patient safety goal 2009
NATIONAL PATIENT SAFETY GOAL 2009

2009 National Patient Safety Goal or (NPSG.07.04.01) requires:

Implementation of best practice or evidence-based guidelines to prevent central line-associated bloodstream infections (CLABSIs) for short and long-term central venous catheters (CVCs) including PICCs

The deadly cost of CLABSIs:

~ 90 % of CLABSIs occur with CVCs

Estimate of 14,000 – 28,000 lives lost per year

Hospitalization prolonged a mean of 7 days

Hospitalization costs ↑~ $3,700 - $29,000

October 1, 2008 CMS (Medicare) no longer

reimbursing for CLABSIs acquired in the hospital

11/17/2014

University Hospitals

University Hospitals

2

how can we impact central line associated blood stream infections clabsis
How Can We IMPACT Central Line Associated Blood Stream Infections (CLABSIs)?
  • What is the Central Line Bundle?

Includes the following bundle of 5 care components:

1. Hand hygiene

2. Maximal barrier precautions

3. Chlorhexidine skin antisepsis

4. Optimal catheter site selection

5. Daily review for line necessity and assessment with prompt removal of unnecessary lines

University Hospitals

hand hygiene just do it
HAND HYGIENE – Just do it!

1. Perform hand hygiene before assisting with catheter insertion or manipulation.

2. Palpation of the insertion site should not be performed after antiseptic cleanse, unless aseptic technique is maintained.

3. Before and after inserting, replacing, accessing, repairing or dressing a central line.

University Hospitals

maximal barrier precautions
MAXIMAL BARRIER PRECAUTIONS

Use strict adherence as the inserter and all involved with the placement of a central line or guidewire exchange with the following:

  • Compliance with hand hygiene
  • Wear cap, mask, sterile gown and sterile gloves
  • Cap – covers all hair
  • Mask – covers nose and mouth tightly
  • Sterile drape – covers patient from head to toe with a small opening for line placement

University Hospitals

chlorhexidine skin prep
CHLORHEXIDINE SKIN PREP
  • Chlorhexidine (CHG) skin prep prior to placement and for dressing change.
  • PINCH wings on CHG applicator.
  • PRESS sponge against the skin allowing the solution to penetrate the pad.
  • PREP covering a large area using a back and forth, up and down, and diagonal friction scrub for at least 30 seconds. Allow to dry. Do not wipe, blot or fan.

University Hospitals

optimal catheter site selection
OPTIMAL CATHETER SITE SELECTION

Subclavian vein is the preferred site for non-tunneled catheters and is associated with lower risk of CLABSIs rather than the jugular vein.

-Femoral site is associated with greater risk of infection and DVTs in adults.

University Hospitals preferred sites:

  • Subclavian and Internal jugular are preferred sites.
  • Femoral site would be an option for:

1. ECMO

2. Neuroprotective hypothermia-thermaguard 

    • Other insertion sites are not able to be accessed due to poor vascular upper extremities, etc.

4. A need for dialysis or other patient emergencies

University Hospitals

new central line dressing at uh tegaderm hcg
NEW CENTRAL LINE DRESSING AT UH: TEGADERM HCG

Studies have shown chlorhexidine gel pad effectively reduces skin flora

Gel pad easily conforms to body contours

Gel pad is transparent

Gel pad adsorbs fluids & blood

Remains effective & transparent over weeks time

No need to manipulate catheter placing gel pad

Tegaderm dressing eliminates Statlock need

University Hospitals Seidman Cancer Center

8

steps following insertion
STEPS FOLLOWING INSERTION

Flush each lumen with 10ml normal saline solution via a 10cc syringe.

Apply sterile, occlusive dressing to site.

Attach male Luer-lock stopcock or Luer-lock IV tubing to each port and close clamps.

MD should order x-ray to confirm placement prior to infusion for subclavian and internal jugular lines. X-ray confirmation is not necessary for femoral lines.

MD should order CENTRAL LINE CARE/MAINTENANCE

Complete Procedure note-general in UHCare. Label as to type of line inserted.

Document daily assessment and need on progress note.

Assess for infiltration, phlebitis, infection, and any change from baseline appearance

11/17/2014

University Hospitals

9

daily line assessment and review
DAILY LINE ASSESSMENT AND REVIEW
  • The risk of CLABSIs increases over time.
  • Complete daily assessment of central line for infection.
  • Prompt removal of unnecessary lines.
  • The replacement of temporary catheters in the presence of bacteremia is not an acceptable replacement strategy. The source of infection is usually colonization of skin tract from the insertion site to the vein.

Roles in Daily Site Assessments:

  • Physicians should assess and document daily the criteria for the patient to maintain a central line.
    • For example: “R internal jugular CVC- clear, dry, intact, no erythema noted. Still necessary for IV access on pressors, etc.”
  • Should be discussed during daily attending rounds.

University Hospitals

central line maintenance order
CENTRAL LINE MAINTENANCE ORDER!

Central line maintenance includes:

  • Dressing, cap and tubing changes per protocol.
  • Scrubbing injection caps with alcohol for 15 seconds prior to accessing.
  • Daily review of line need.
  • Prompt removal of unnecessary lines.

HOW TO ORDER ON EMR?

  • CENTRAL LINE CARE/MAINTENANCE (order set)

University Hospitals

be a patient advocate
BE A PATIENT ADVOCATE!
  • Be a bundler and protect your patients.
  • Educate others in the central line bundle.
  • Follow-up with management with other

ideas to support bundle compliance.

  • Evaluate the effectiveness of this strategy within your unit.

University Hospitals

reducing central line associated bloodstream infection clabsi national patient safety goal 7
Reducing Central Line Associated Bloodstream Infection (CLABSI) - National Patient Safety Goal #7.
  • What is the Central Line Bundle? Includes the following 5 care components:
  • Hand hygiene
  • Maximal barrier precautions
    • Hat, mask, sterile gown, sterile gloves, sterile drape covering the entire patient
    • Cap and mask must be worn by all personnel entering the room.
    • STOP insertion if sterile technique is broken. If sterility is broken, a new kit and/or new drapes should be applied to patient and MD should start procedure over again.
  • Chlorhexidine skin antisepsis (if allergic use Betadine or alcohol)
  • Optimal catheter site selection
    • Subclavian most preferred site, then internal jugular vein, femoral vein (emergency)
  • MUST DOCUMENT DAILY CENTRAL LINE ASSESSMENT with 2 components:
    • Infection with prompt intervention when indicated
    • Necessity with prompt removal when no longer required
    • Should be part of the physical exam and assessment/plan
    • Remember the motto: “It does not count unless you document.”
  • Pre-procedure. Provide acceptable rational for line placement. Obtain informed consent and provide central line educational information. Perform time-out procedure using Universal Protocol (correct patient, correct side, correct site).
  • Post-procedure.
  • Obtain Chest X-ray if indicated.
  • Write PROCEDURE NOTE as soon as procedure has been performed.Must include the components above.
  • Place an order for central line maintenance.
    • HOW TO ORDER: On Orders tab, Type CENTRAL LINE CARE/MAINTENANCE