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Advanced practice nursing: the role of the nurse in the prevention and management of CRBSI

Advanced practice nursing: the role of the nurse in the prevention and management of CRBSI. Timothy R. Spencer , RN, APN, DipAppSci, Bach.Health, ICCert Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service

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Advanced practice nursing: the role of the nurse in the prevention and management of CRBSI

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  1. Advanced practice nursing: the role of the nurse in the prevention and management of CRBSI Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service Conjoint Lecturer, University of NSWDept of Critical Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia

  2. What we already know • Nurses provide majority of care to VADs • > ~95% hospital admissions will have some form of VAD • Often first line of management during any given hospital admission

  3. Early Assessment/Intervention • Selection of device based on a needs assessment • Minimises the need for certain inappropriate devices • Ongoing monitoring is essential • Products/device review and analysis • Defining terminology and reporting outcome measures

  4. Prevention of infection. • Maintaining a closed IV system. • Maintaining a patent device. • Preventing damage to the device (Mallett and Bailey 1996). • Surveillance, management, and leadership following project implementations

  5. CRBSI or CLABSI? Confused yet? • Terminology can be a little confusing. • CRBSI ~ is a rigorous clinical definition, defined by precise laboratory findings that identify the CVC as the source of the BSI and, used to determine diagnosis, treatment, and possibly epidemiology of BSI in patients with a CVC. (APIC 2009) • CLABSI ~ used only for surveillance purposes to identify BSIs that occur in the population at risk (patients with central lines). (APIC 2009)

  6. CDC says what.. • CRBSI criteria require one of the following: • A positive semi quantitative (>15 colony-forming units [CFU]/catheter segment) or quantitative (>103CFU/catheter segment) cultures whereby the same organism (species and antibiogram) is isolated from the catheter segment and peripheral blood • Simultaneous quantitative blood cultures with a ≥5:1 ratio CVC versus peripheral • Differential period of CVC culture versus peripheral blood culture positivity of >2 hours

  7. A CLABSI as defined by CDC, is a primary (i.e, no apparent infection at another site) BSI in a patient that had a central line within the 48-hour period before the development of the BSI. BSI is defined using either laboratory confirmed bloodstream infection (LCBI) or clinical sepsis (CSEP) definitions • In the CDC/NHSN definition of CLABSI, there is no minimum period of time that the central line must be in place in order for the BSI to be considered central line–associated. • The culture of the catheter tip is not a criterion for CLABSI!

  8. Involving people.. • While most facilities have traditionally disseminated infection data to hospital-wide committees and administration, it is essential to also share this information with the people who can actually make a difference—the direct care providers. Involving proceduralists who place the central venous catheters provides valuable feedback on potential technique issues.

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