Disclosures • Teleﬂex Ultrasound-‐guided central venous & arterial access: compliance within prac=ce – Faculty Member
What we already know • Currently, nurses provide majority of care to VADs • > ~95% hospital admissions will have some form of VAD within 24hr of admission • OSen ﬁrst line of management during any given hospital admission -‐ ER • Vascular access procedures are the most commonly performed invasive procedure in the world today.
What we already know • With that knowledge, clinicians need to be aware of the types of CVCs available, the advantages and disadvantages of each type, and how catheter selec=on and implementa=on of recommended preven=ve strategies can impact the CRBSI rate. • These devices and strategies work together as a collabora=ve approach but cannot individually provide the signiﬁcant impact needed to aﬀect CRBSIs.
Early Assessment • Selec=on of device(s) based on a needs assessment • Minimises the need for inappropriate devices • Ongoing monitoring is essen=al • Products/device review and analysis • Deﬁning terminology and repor=ng outcome measures
The powers of observa=on.. Shoe leath er surveillanc e is the best form of monitorin g
Interven=on • Preven=on of infec=on • Maintaining a closed IV system • Maintaining a patent device • Preven=ng damage to the device (Malleb and Bailey 1996) • Surveillance, management, and leadership following project implementa=ons
CDC says what.. • CRBSI criteria require one of the following: – A posi=ve semi quan=ta=ve (>15 colony-‐forming units [CFU]/catheter segment) or quan=ta=ve (>103CFU/ catheter segment) cultures whereby the same organism (species and an=biogram) is isolated from the catheter segment and peripheral blood – Simultaneous quan=ta=ve blood cultures with a ≥5:1 ra=o CVC versus peripheral – Diﬀeren=al period of CVC culture versus peripheral blood culture posi=vity of >2 hours
• A CLABSI as deﬁned by CDC, is a primary (i.e, no apparent infec=on at another site) BSI in a pa=ent that had a central line within the 48-‐hour period before the development of the BSI. BSI is deﬁned using either laboratory conﬁrmed bloodstream infec=on (LCBI) or clinical sepsis (CSEP) deﬁni=ons • In the CDC/NHSN deﬁni=on of CLABSI, there is no minimum period of /me that the central line must be in place in order for the BSI to be considered central line–associated. • The culture of the catheter -p is not a criterion for CLABSI!
Involving people.. • While most facili=es have tradi=onally disseminated infec=on data to hospital-‐wide commibees and administra=on, it is essen=al to also share this informa=on 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 poten=al technique issues.
Products • Analysis of speciﬁc types of products, (e.g. catheters, valves, site dressings, ﬂuid bags, accessory products), con=nues to have beneﬁt. • But the true value of a speciﬁc product is best recognized in rela=on to all products that make up the pa=ent’s IV system.
Educa=on and training • Mul=ple studies have demonstrated improvement with educa=on and training • Physicians have currently no creden=aled/ standardized method for learning catheter inser=on • Many nurses have very lible exposure to principles and prac=ces of catheter management • See one, do one, teach one method is NOT an adequate educa=onal tool! • Mul=disciplinary group to create educa=onal plan
Preven=ons matched with source of organisms Skin • Hand hygiene • Skin an=sepsis • Inser=on site • Maximal barriers • Catheter stabiliza=on • Dressings • An=microbial catheters
Preven=ons matched with source of organisms Infusate • Single use ﬂushing system • Laminar air ﬂow work bench • Strict adherence to asep=c technique when
Preven=ons matched with source of organisms Catheter hub manipula=on • Hand hygiene • Number of catheter lumens • Hub an=sepsis • Tubing and cap changes • Flushing procedures • An=microbial catheters • Needleless injec=on devices
Who’s who in the zoo! • Reducing CRBSI is EVERYONES business, not just one clinician specialty • Nurses, physicians, respiratory therapists, technicians, as well as pa=ents themselves, take the responsibility to prevent infec=ous complica=ons through constant vigilance in monitoring the device Its not your -tle, but it’s the diﬀerence you make at the bedside that counts
Tim.Spencer@sswahs.nsw.gov.au • Webcast was to share knowledge and best prac=ces on IV therapy management including CLABSI preven=on and beyon hbp://vioca.st/Andrew_Jackson_Infec=on_Preven=on_IV_Management_Educa=onal_Webcast
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