Catheter Related Bloodstream Infections & Preventing Spread of Bloodborne Pathogens

1. Catheter Related Bloodstream Infections&Preventing Spread of Bloodborne Pathogens West Virginia Northern Community College Patient Care Technician Bloodborne Pathogen Discussion

2. What is a central catheter? • A central venous catheter, also called a central line, is a long, thin, flexible tube used to give medication, fluids, blood products or monitor central venous pressure. These catheters are designed for short-term use of a week to two weeks (Haller,2002). • The catheter is often inserted in the arm, chest or groin through the skin into a large vein.

3. How does the infection occur? • Bloodstream infections can occur as a side effect from treatment received in an ICU, IMU, or wherever a patient may be with a CVAD. • A bloodstream infection begins when a pathogen enters the line from bacteria. • According to the Center for Disease Prevention 1 in every 20 patients obtain an infection while during their hospital stay(Adams,2009).

4. CDC Reports on Catheter Related Infections • In 2010 18,000 catheter related infections occurred in ICU’s in the hospitalized patient. • Catheter related bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 who gets them. • Infections are one of the leading causes of hospitalization and death(Adams,2009).

5. Steps to prevent catheter related infections. Based on evidenced based practice. • Evidenced based practice through randomized, controlled trials has proven and provides a solid foundation to identify that nursing care activities help prevent catheter related blood stream infections (McKinney, 2006). • Care “bundles” are groupings of best practices that pertain to a specific disease process. Implementing the bundles in practice has shown results in better outcomes for decreasing infection (O’Grady,2011).

6. Care Bundles in practice • One proposed central-line care bundle is based on a protocol used at Rady Children’s Hospital in San Diego (McKinney, 2006). Proven effective in preventing catheter related central line infections, it includes the following components: • Hand hygiene. For healthcare workers caring for a patient with an intravascular line, rigorous hand hygiene is critically important to remove transient hand flora that may have been picked up from other patients or environmental surfaces (Ridley, 2011). • Maximal barrier precautions during insertion. During line placement, the patient should be covered with a sterile drape from head to toe, with a small opening at the insertion site. The operator must wear a cap, mask, sterile gown, and sterile gloves.

7. Care Bundles • Chlorhexidine skin antisepsis. Evidence shows chlorhexidine is more effective than povidone-iodine or alcohol in reducing skin flora around the insertion site and has a residual effect not seen with povidone-iodine or alcohol (Ridley, 2011). • Optimal catheter-site selection with femoral-vein avoidance in adults due to bowel/urine contamination. Although many intensivists and anesthesiologists prefer the internal jugular site for easier insertion, evidence suggests that lines placed using the subclavian vein have the lowest infection risk. • Daily review of line necessity, with prompt removal of unnecessary lines. Every day a catheter stays in place, a risk exists that infectious organisms may gain entry through the insertion site or by line manipulation (Ridley, 2011).

8. Benefits to decreasing the number of catheter related infections. • The benefits to decreasing the number of line related infections would be shorter length of stay for the patient, and lower cost to both the hospital and the patient (Haller, 2002). • Hospital infections add more than $30 billion annually to the nation's health tab in hospital costs alone. • Hospital-acquired infections add considerable morbidity and mortality to patient care. By taking the steps to decrease central line infections we can increase quality of care provided to the patients and decrease length of stay, which in turn will decrease the chance of a hospital acquired infection (Skilton, 2008).

9. Bloodborne Pathogens • AIDS, Hepatitis B, and Hepatitis C are bloodborne infections caused by bloodborne pathogens (disease causing agents found in the blood). • HIV, HBV, and HCV are not only found in the blood, but in other body fluids that may contain blood, such as: urine, vaginal secretions, semen, fluids from around an unborn baby, the spine, heart, lungs, or joints, and tissue removed from the body. • All body fluids, if unable to differentiate between body fluids, should be considered infectious.

10. Bloodborne Pathogens • HIV, the precursor to AIDS can live in ones body from several weeks to several months before developing symptoms. Though symptoms may only last a few days, once exposed, you are a permanent carrier of the AIDS virus, and able to infect others. • HIV, though it may take up to 10 years, can develop into the AIDS virus. • Acquiring AIDS leaves you helpless against fighting off infections, along with other symptoms such as diarrhea, weight loss, fevers, confusion, memory loss, depression, motor dysfunction. • AIDS is terminal, and acquiring infections like TB, pneumonias, and cancers will lead to death.

11. Bloodborne Pathogens • HBV-Infected individuals breakdown: • 1/3 No Symptoms • 1/3 Mild Flu-Like Symptoms That Will Resolve • 1/3 Clinically Diagnosable HBV • 6% - 10% of individuals infected with HBV will become chronic, life-long carriers of HBV, with or without an active infection, with few to no symptoms, but will be able to transmit the disease. • >2% will die from acute or chronic HBV. • Vaccination is the number one prevention of acquiring HBV and treatment may be effective if initiated immediately.

12. Bloodborne Pathogens • Hepatitis C infections are the most common chronic bloodstream infections in the US. • An estimated 4.1 million people are carriers of the HCV. • There are NO vaccines or immune globulin products available to prevent transmission. • HCV will ultimately lead to death, related to serious liver disease.

13. Modes Of Transmission • Transmission Outside of the Workplace Include: • Sexual Contact (vaginal secretions, semen, blood) • Drug Users (sharing of needles) • Transfusions of Infected Blood (though screening of blood has cut down on this mode significantly) • Mother-to-Child in Utero

14. Modes Of Transmission • Transmission Inside the Workplace Include: • Puncture Wounds from contaminated needles, or sharp instruments. • Contact With Broken Skin (even the smallest of nicks in your skin or a paper cut are large enough to allow infection in). • Mucous Membranes (the membranes that line your eyes, nose, and mouth can be infected by touching them with contaminated hands or by the splashing of fluids if proper protective equipment is not utilized).

15. Prevention of Transmission • Universal Precautions, originally developed by the CDC is a key component of OSHA’s Bloodborne Pathogen Standard. • Standard precautions: Apply to all blood and body fluids, secretions and excretions, with the exception of sweat, tears, and intact skin. • Both Universal & Standard Precautions apply to every person, whether an existing infection is known or not. • CDC has further developed extended precautions known as, airborne, droplet, and contact precautions that must be used along with Universal and Standard Precautions.

16. Prevention of Transmission • Immediate Reporting of an exposure can help control bloodborne infections. • Wash exposed site immediately. • Inform your supervisor of the incident. • Consult a doctor without delay. • A post-exposure follow-up will as well be required. • OSHA requires that blood be drawn immediately and tested for baseline results to use for comparison later.

17. Post Exposure Prophylaxis • If exposed, CDC (2012), states that a prophylaxis may be required to reduce the risk of infection. • For HIV, AZT in combination with other drugs may be used, depending on the severity of the exposure. • For HBV, Persons who have written documentation of a complete hepatitis B vaccine series and who did not receive post vaccination testing should receive a single vaccine booster dose. • Persons who are in the process of being vaccinated but who have not completed the vaccine series should receive the appropriate dose of hepatitis B immune globulin (HBIG) and should complete the vaccine series. • Unvaccinated persons should receive both HBIG and hepatitis B vaccine as soon as possible after exposure (preferably within 24 hours). Hepatitis B vaccine may be administered simultaneously with HBIG in a separate injection site. The hepatitis B vaccine series should be completed in accordance with the age-appropriate vaccine dose and schedule (1st dose after exposure, 2nd dose 1 month after first dose, and 3rd dose is 6 months after). • For HCV, interferon, though not recommended currently, may increase the rate of resolved infection if started soon enough.

18. Post Exposure Prophylaxis • If exposed, CDC (2012), states that a prophylaxis may be required to reduce the risk of infection. • For HIV, AZT in combination with other drugs may be used, depending on the severity of the exposure. • For HBV, Persons who have written documentation of a complete hepatitis B vaccine series and who did not receive post vaccination testing should receive a single vaccine booster dose. • Persons who are in the process of being vaccinated but who have not completed the vaccine series should receive the appropriate dose of hepatitis B immune globulin (HBIG) and should complete the vaccine series. • Unvaccinated persons should receive both HBIG and hepatitis B vaccine as soon as possible after exposure (preferably within 24 hours). Hepatitis B vaccine may be administered simultaneously with HBIG in a separate injection site. The hepatitis B vaccine series should be completed in accordance with the age-appropriate vaccine dose and schedule (1st dose after exposure, 2nd dose 1 month after first dose, and 3rd dose is 6 months after). • For HCV, interferon, though not recommended currently, may increase the rate of resolved infection if started soon enough.