Measures to Prevent Central Line Associated Bacteremia In the ICU Candace Anglea, RN, CIC Infection Control Practitione

1. Measures to PreventCentral Line Associated BacteremiaIn the ICU Candace Anglea, RN, CICInfection Control Practitioner

2. Demographics • 541 bed acute care facility • Average daily census 275+ • A member of STHS – 4 hospital system • -STH, Baptist, MTMC, Baptist Hickman • Over 10,000 employees systemwide • Primary services include: • - Cardiac, Orthopedic, Neurosurgery, • Oncology • One Infection Control Practitioner!!

3. Saint Thomas ICU’s Pods- 40 beds 5 Pods- 8 beds per pod *Average 650 line days per month Special Care Units- 60 beds *Average 500 line days per month *Approximately 1,000 ICU line days per month

4. ICU staffing • Intensivists- Physicians board certified in • Anesthesia and Critical Care Medicine • Only Intensivists insert and change lines- • no residents • Lines are routinely changed q 4 days- • (does not include PICC’s) • Critical Care Nurse Practitioners- • (Both Cardiac and Med/Surg) • RN’s and Support Staff

5. Standardized Line Carts • Standardized line carts are kept in designated areas with frequent line insertions- • Pods • Special Care Units • Holding rooms • OR • ER

6. Central Line Insertion Checklist • Developed and implemented August 2007 • Forms are kept on top of line carts for RN • who assists with procedure to fill out at the • time of insertion • Infection Prevention picks forms up weekly • Data reviewed for trends- • Max barrier precautions, hand hygiene, etc.

7. Maximal Barrier Precautions • Currently central line kits are not inclusive • Gowns, hats, masks, are kept on carts but • pulled as separate items • Chloraprep not in all kits but kept on cart • Drape- do not currently use a full body • head to toe drape • Looking at drape options currently

8. Challenges • Implementation of full body drape • Implementation of safe sharp devices to meet • OSHA requirements • 2 different OR’s- Cardiac and Main OR • 2 different anesthesia groups • Different practices- one group uses drape in • kits; other group uses sterile towels • Site selection approximately 50/50 for • Subclavian vs IJ • IJ’s placed for convenience at times

9. Successes • Intensivists play a critical role • Daily assessment of patients with lines • during ICU rounds • Very actively engaged in Infection • Prevention- Chief of Anesthesia on ICC • Proud of sustained low BSI rates • BSI rate at zero > 2 years!

10. PICC lines • Inserted by IV Therapy Team • Radiology inserts PICC’s if IV therapy not • successful • Have recently implemented Maximal Barrier • Kits with all PICC insertions • Safety needles used • Challenges with dressing/site care not • always done per policy • Majority of BSI infections are r/t PICC’s

11. Dressing Changes/Site Care Protocols • All Central Line Dressings q 96 hours & • PRN • All PICC Line Dressings q 7 days and PRN • All IV tubing changes q 96 hrs- exceptions • for blood, TPN, Lipids, other lipid solutions • Use CHG for all dressing changes/PIV’s • All ports to be cleaned with alcohol wipe • before use

12. Questions? Contact Information: canglea@stthomas.org 615-222-3806 Thank You!

13. Dressing Changes/Site Care Protocols • All Central Line Dressings q 96 hours & • PRN • All PICC Line Dressings q 7 days and PRN • All tubing changes q 96 hrs • Use CHG for all dressing changes/PIV’s • All ports to be cleaned with alcohol wipe • before use