Preventing Central Line-Associated Bloodstream Infection (CLABSI) at Community Medical Center

1. Preventing Central Line-Associated Bloodstream Infection (CLABSI) at Community Medical Center

2. Background • 250,000 Central Veneous Catheter (CVC) related blood stream infections occur in the United States each year, with a mortality of 12% to 25% per infection • 30,000 to 48,000 patients die each year as a result of CLABSI’s-That’s 248 plane crashes a year • Each CLABSI cost an average of $3,700 to $25,000 • Increasing the length of hospital stay by an average of 7 days.

3. Risk Factors • Prolonged hospitalization before catheterization • Prolonged duration of the catheterization • Internal jugular catheterization • Femoral catheterization • Environment: Bacteria lives on walls, floors, side bed rails… • Microbial colonization at insertion site • Microbial colonization of the catheter hub

4. CMC is raising the bar • Nationwide efforts are trying to reduce preventable deaths in hospitals and CMC is in the fore front of this initiation • One of the ways identified to help reduce central line associated bloodstream infections (CLABSI) is by “Bundling” our central line procedure. • Bundling is taking 3-5 evidenced based practices or precautionary steps and put them together and implementing them together • When all of the practices/precautionary steps are done together the results equal improved quality patient care

5. Central line Bundling • The Central Line Safety Checklist & The Central Line Maintenance Sheet is attached to the central line insertion kit • Use it for central line insertion and maintenance • Fax both sheets after insertion to Infection Control @ 329-4575, then turn it in to your manager • Hand Hygiene • Wash hands before donning on gloves and after procedure

6. Central line bundle continued • Maximal Barrier Precautions • New Central Line Supplement kit will be used in addition to the central line insertion kit • It will include sterile: cap (2), gown (2), mask (2), medication labels, Chlorhexidine swab (1), central line SorbaViewSecurement dressing (1), and a Biopatch (1) • Cover patient head to toe with the fenestrated section at the insertion site • The subclavian is the optimal insertion site (femoral and jugular is not recommended by CDC, it increases the risk of infection.) • Physician and assistant: Wear cap, gown, sterile gloves and mask. • After insertion: • Place Biopatch at insertion site, then secure with the SorbaViewSecurement dressing • Do not suture central line in patient • It increases patient discomfort and increase risk for infection

7. Chlorhexidine • The formulation of 2% CHG and 70% Isopropyl alcohol. They work together to provide the most rapid and persistent antimicrobial activity on the skin surface and acts fast on a broad spectrum of bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), and keeps fighting bacteria for at least 48 hours. It supports infection control guidelines for helping to reduce the incidence of blood stream infections • To use • Pinch the wings on the swab and release • Gently press the sponge against the treatment area • Apply friction rub for 30 seconds on the upper torso and allow to dry for 30 seconds • For lower torso rub for 2 minutes and allow to dry for 1 minute • Important Reminder • Do not use on pediatrics weighing less than 1000 grams and/or < 2 months of age, and do not use on pediatrics who do not have good skin integrity

8. Biopatch • Benefits: • Broad Spectrum antimicrobial and antifungal agent • Continually releases chlorhexidine gluconate for 7 days • Absorbs up to 8 times it’s own weight • BIOPATCH is proven to reduce CLABSI’s by 60% in patients with central venous catheters • Precautions: • Do not use on pediatrics weighing less than 1000 grams and/or <2 months of age, and do not use on pediatrics who do not have good skin integrity • Do not place on infected wounds. It is not intended to be used as a treatment of percutaneous infections • Important points to remember: • PLACE BLUE (shiny) SIDE UP • To be used on all central line insertions and changed when dressing change occurs (24 HOURS AFTER INSERTION, then EVERY 7 DAYS)

9. Securement Dressing • Do not suture central line into patient as this : • Increases patient discomfort • Increases risk for infection • Suturing increases risk of needle stick • Change Securement dressing 24 hours after insertion, then every 7 days(use central line dressing change kit)

10. Daily Review of Central line • Document on Central line flowsheet • Central line insertion date • Daily assessment of insertion site (each shift) • Evaluate all central lines daily with physician and remove nonessential lines We are all an essential piece in preventing infections. Help out patients get the best quality care here at CMC and be a role model to other hospitals References: CDC, 1000 Lives Campaign Institute for Healthcare Improvement: Implement the Central Line /IHI/Topics/Critical Care/intensive Care/Changes, last accessed 4/09 Society of Healthcare Epidemiology of America , Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals 2008 http://www.medicinenet.com/mrsa_picture_slideshow/article.htm, Last accessed 4/09 PP by Scappel 09

11. References • CDC, 1000 Lives Campaign • Institute for Healthcare Improvement: Implement the Central Line http://www/IHI/Topics/Critical Care/intensive Care/Changes last accessed 4/09 • Society of Healthcare Epidemiology of America , Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals 2008 • http://www.medicinenet.com/mrsapicture_slideshow/article.htm Last accessed 4/09 • PP by Scappel/Jshaw 09