Central Line AssociatedBloodStream Infections (CLABSIs) By: Richel Grace T. Baldoza
Central Line-Associated Bloodstream Infection• Infection can occur when bacteria grow in the line and spread into the bloodstream.• is a primary blood stream infection (BSI) in a patient that had a central line within the 48 hour period before the development of the BSI• If BSI develops in a patient within 48 hours of discharge from a location, attribute the CLABSI to the discharging location.
Central Line-Associated Bloodstream Infection• Signs or symptoms: temperature above normal, fever, chills, or the skin around the central venous catheter (CVC) is painful, red, swollen or oozing,
Laboratory Confirmed Bloodstream Infection CRITERIA 1 Organism cultured Patient has a recognized from blood is notpathogen cultured from one related to an infection or more blood cultures No at another site. Yes Yes No CRITERIA 2 Patient has at least one of the following signs or symptoms: fever (>38ºC), chills, or hypotension No Yes Signs and symptoms and positive laboratory results NO are not related to an Central line associated infection at another site No bloodstream infection YesCommon skin contaminant is cultured from two ormore blood cultures drawn on separate occasions No Yes Central line associated bloodstream infection
Central Line or Central Venous Catheter• A vascular infusion device that terminates at or close to the heart or in one of the great vessels and is used for infusion, withdrawal of blood, or hemodynamic monitoring.
The following are considered great vessels forthe purpose of reporting central line associated infections and counting central line days• Aorta • Brachiocephalic veins• Pulmonary artery • Internal jugular veins• Superior vena cava • Subclavein veins• Inferior vena cava • External iliac veins• Umbilical artery and vein for neonates • Common femoral veins
Modifiable Risk FactorsCharacteristic Greater Risk Lower RiskInsertion Emergency electivesercumstancesSkill of inserter General specializedInsertion site 70% alcohol 2% chlorhexidine 10% povidone- iodineCatheter lumens Multilumen single lumenDuration of catheter Longer duration ofuse use greater riskBarrier precautions Submaximal maximal
Central Line CareA. Dressing:1. All dressing shall be changed using sterile technique.2. Initial dressing should be left in place for 24hrs unless heavy soild3. Gauze dressing should be changed daily for seven (7) days followinginsertion, then every forty eight (48) hour if no signs of infection or if thedressing becomes loose, wet or soiled.
B.Frequency of Flushing 1. A physician’s order is required to flushed with heparin 10 u/ml. 2. Flush before and after every use of antibiotics blood products utilize SASH technique. S- Flush the device with 10 ml 0.9% sterile saline A- administer the medication/ drw blood work S- Flush the device with 10ml 0.9% sterile saline H- Flush the device with 2ml heparin (10 u/ ml) 3. Flushed twice a day, if no IV fluids infusing or treatment.
C. The catheter is to be looped and anchoredwith taped.D. Required to keep vein openE. Not required to swab for culture andsensitivity from central line insertion site thatappears infected, however the physician mustbe notified that the site looks infectedF. Change all injection ports every three days.
To prevent catheter-associated bloodstream infectionsdoctors and nurses will: • Choose a vein where the catheter can be safely inserted and where the risk for infection is small. Subclavian Vein First Choice
• Clean their hands with soap and water or an alcohol-based hand rub before putting in the catheter.
• Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it sterile. The patient will be covered with a sterile sheet.
• Clean their hands, wear gloves, and clean the catheter opening with an antiseptic solution before using the catheter to draw blood or give medications. Healthcare providers also clean their hands and wear gloves when changing the bandage that covers the area where the catheter enters the skin.
• Clean the patient’s skin with an antiseptic cleanser before putting in the catheter.
• Decide every day if the patient still needs to have the catheter. The catheter will be removed as soon as it is no longer needed.
Carefully handlemedications and fluidsthat are given throughthe catheter.
Some patients are sent home from the hospital with a catheter in order tocontinue their treatment.• Make sure you understand how to care for the catheter before leaving the hospital. For example, ask for instructions on showering or bathing with the catheter and how to change the catheter dressing.• Make sure you know who to contact if you have questions or problems after you get home.
Some patients are sent home from the hospital with a catheter in order tocontinue their treatment.
• Make sure you wash your hands with soap and water or an alcohol-based hand rub before handling your catheter.
• Watch for the signs and symptoms of catheter-associated bloodstream infection, such as soreness or redness at the catheter site or fever, and call your healthcare provider immediately if any occur.
Personal Protective Equipment ( PPE) Refers to protective clothing, helmets, goggles, or other garment or equipment designed to protect the worker’s body Purpose from injury by blunt impacts, electrical hazards, heat, chemicals and infection, for job- Designed to protect related occupational safety the skin and mucuos and health purposes membranes of the eyes, nose and mouth from exposure to blood or other potentially infectious material.