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:
The Central Line Bundle and YOU!
Quality Assurance/Peer Review Report
Privileged Pursuant to O.R.C. Section 2305.24, .251, .252
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
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
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.
Use strict adherence as the inserter and all involved with the placement of a central line or guidewire exchange with the following:
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:
2. Neuroprotective hypothermia-thermaguard
4. A need for dialysis or other patient emergencies
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
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
Roles in Daily Site Assessments:
Central line maintenance includes:
HOW TO ORDER ON EMR?
ideas to support bundle compliance.