16.00 16.30 tim spencer - publiceren
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  • 1. Disclosures  •  Teleflex  Ultrasound-­‐guided  central  venous  &   arterial  access:  compliance  within  prac=ce  –   Faculty  Member  
  • 2. 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.  
  • 3. 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.    
  • 4. Typical  ICU  trauma  pa=ent;  ~  mul=-­‐infusion  therapy  ~  mul=ple  wounds  Portals  for  cross-­‐infec=on?  
  • 5. 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  
  • 6. The  powers  of  observa=on..   Shoe  leath er   surveillanc e  is  the   best  form   of   monitorin g  
  • 7. 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  
  • 8. CRBSI  or  CLABSI?  Confused  yet?  
  • 9. 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  
  • 10. •  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!  
  • 11. 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.  
  • 12. Maximal  barrier..  
  • 13. 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.    
  • 14. 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    
  • 15. 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  
  • 16. Preven=ons  matched  with  source   of  organisms  Infusate   •  Single  use  flushing  system   •  Laminar  air  flow  work  bench   •  Strict  adherence  to  asep=c  technique  when    
  • 17. 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  
  • 18. 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  
  • 19. 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