The document discusses healthcare-associated infections that can occur from invasive medical devices like central venous catheters, including central line-associated bloodstream infections. It covers the epidemiology, etiology, pathogenesis, risk factors, prevention strategies and clinical definitions of central line-associated bloodstream infections. The strategies to prevent CLABSIs include following best practices for catheter insertion and maintenance, hand hygiene, and using bundles that incorporate multiple evidence-based practices.
Prevention of Central Line Associated Blood Stream Infection (CLABSI )[compa...drnahla
Infection Control Guidelines for Prevention of Central Line Associated Blood Stream Infection (CLABSI )
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
Prevention of Central Line Associated Blood Stream Infection (CLABSI )[compa...drnahla
Infection Control Guidelines for Prevention of Central Line Associated Blood Stream Infection (CLABSI )
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) is the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
Using the Central Line Bundle
Hand Hygiene
Remove Unnecessary Lines
Use of Maximal Barrier Precautions
Chlorhexidine for Skin Antisepsis
Avoid femoral lines
Report CLABSI rates to the units
Celebrate success!!
Introduction to the Visual Infusion Phlebitis (VIP) scoreivteam
The Visual Infusion Phlebitis score is a standardised approach to monitoring peripheral IV catheter sites.
The fact that it encourages site observation means that it also has an impact on other peripheral IV catheter problems such as dislodgement, infiltration and infection.
The innovation of this tool is the recognition of the visual nature of peripheral IV problems and the subsequent benefits of a visual tool to identify these issues early.
As health care workers we have a duty of care to monitor the condition of a patients IV site.
Failure to monitor IV sites is seen as failure in duty of care.
The VIP score is internationally acknowledged as a proven standardised tool for the monitoring of peripheral IV catheter sites.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) is the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
Using the Central Line Bundle
Hand Hygiene
Remove Unnecessary Lines
Use of Maximal Barrier Precautions
Chlorhexidine for Skin Antisepsis
Avoid femoral lines
Report CLABSI rates to the units
Celebrate success!!
Introduction to the Visual Infusion Phlebitis (VIP) scoreivteam
The Visual Infusion Phlebitis score is a standardised approach to monitoring peripheral IV catheter sites.
The fact that it encourages site observation means that it also has an impact on other peripheral IV catheter problems such as dislodgement, infiltration and infection.
The innovation of this tool is the recognition of the visual nature of peripheral IV problems and the subsequent benefits of a visual tool to identify these issues early.
As health care workers we have a duty of care to monitor the condition of a patients IV site.
Failure to monitor IV sites is seen as failure in duty of care.
The VIP score is internationally acknowledged as a proven standardised tool for the monitoring of peripheral IV catheter sites.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Introduction
Modern healthcare employs many types of invasive devices
and procedures to treat patients and to help them recover.
Infections can be associated with the devices used in
medical procedures, such as catheters or ventilators.
These healthcare-associated infections (HAIs) include
Central line-associated bloodstream infections(CLABSI)
Catheter-associated urinary tract infections(CAUTI)
Ventilator-associated pneumonia(VAP)
Surgical site infections.(SSI)
-CDC
2
3. Conti…
Central venous catheterization placement was first
described in 1929,and rapidly developed as an
important experimental instrument for studying
cardiac Physiology as well as indispensable clinical
tool in the treatment process.
-Joshua Koilikof
3
4. Central Lines
A central venous catheter (CVC), also known as
a central line, central venous line, or central
venous access catheter, is a catheter placed into a
large vein. It is a form of venous access.
4
5. Medical uses
Difficult peripheral venous access – central venous catheters may be placed when
it is difficult to gain or maintain venous access peripherally (e.g. obesity, scarred
veins from prior cannulations, agitated patient).
Delivery of certain medications or fluids – medications such
as vasopressors (e.g., norepinephrine, vasopressin, phenylephrine etc.),
chemotherapeutic agents, or hypertonic solutions are damaging to peripheral
veins and often require placement of a central line. Additionally, catheters with
multiple lumens can facilitate the delivery of several parenteral medications
simultaneously.
Prolonged intravenous therapies – parenteral medications that must be delivered
for extended periods of time (more than a few days) such as long-term parenteral
nutrition, or intravenous antibiotics are administered through a central line.
Specialized treatment – interventions such as hemodialysis, plasmapheresis,
transvenous cardiac pacing, and invasive hemodynamic monitoring
(e.g. pulmonary artery catheterization) require central venous access.
5
6. Types of central lines
Peripherally inserted central catheter (PICC). This
line is placed in a large vein in the upper arm, or
near the bend of the elbow.
Subclavian line. This line is placed into the vein
that runs behind the collarbone.
Internal jugular line. ...
Femoral line.
Umbilical line(Neonates)
6
7. Types of Central Lines reporting
purposes
1.Permanent central line: Includes:
a) Tunneled catheters, including tunneled dialysis
catheters
b) Implanted catheters (including ports)
2. Temporary central line: A non-tunneled, non-implanted
catheter
3. Umbilical catheter: A vascular catheter inserted
through the umbilical artery or vein in a neonate. All
umbilical catheters are central lines.
7
8. Devices Not Considered CLs
Arterial catheters
Arteriovenous fistula
Arteriovenous graft
Atrial catheters (also known as transthoracic intra-cardiac
catheters, those catheters inserted directly into the right or
left atrium via the heart wall)
Extracorporeal life support (ECMO)
Hemodialysis reliable outflow (HERO) dialysis catheter
Intra-aortic balloon pump (IABP) devices
Peripheral IV or Midlines
Ventricular Assist Device (VAD)
8
9. Difference between CLABSI/CRBSI
CRBSI is a clinical definition, used when diagnosing and treating patients, that
requires specific laboratory testing that more thoroughly identifies the catheter as the
source of the BSI. It is not typically used for surveillance purposes.
A CLABSI is a primary BSI in a patient that had a central line within the 48-hour
period before the development of the BSI and is not bloodstream related to an
infection at another site.
9
10. Epidemiology
CLABSIs lead to prolonged hospital stays and
increase health care costs and mortality
International Nosocomial Infection Control
Consortium (INICC) surveillance data from
January 2010 through December 2015
(703 intensive care units in 50 countries) reported a
CLABSI rate of 4.1 per 1000 central line days.
10
11. Etiology
Based on the National Healthcare Safety Network (NHSN) the order of selected pathogens
associated with causing CLABSI are as follows.
Gram-positive organisms
Coagulase negative staphylococci, 34.1%
Enterococci, 16%
Staphylococcus aureus 9.9% are the most common
Gram negatives
Klebsiella, 5.8%;
Enterobacter, 3.9%;
Pseudomonas, 3.1%;
E.coli, 2.7%;
Acinetobacter, 2.2%),
Candida species (11.8%),
and others (10.5%).
**Approximately 40%–80% of CRBSIs are caused by gram-positive organisms
**20%–30% of infections CRBSIs are caused by gram-negative organisms
11
12. Organism Criteria
Organism(s) cultured from blood must be one of the following
with no other organisms isolated
Bacteroides spp.
Candida spp.
Clostridium spp.
Enterobacteriaceae
Enterococcus spp.
Fusobacterium spp.
Peptostreptococcus spp.
Prevotella spp.
Veilonella spp.
Viridans group streptococci
12
13. Host Factors
Host factors that increase the risk of CLABSI are
Chronic illnesses (hemodialysis, malignancy,
gastrointestinal tract disorders, pulmonary
hypertension)
Immune-suppressed states (organ transplant, diabetes
mellitus)
Malnutrition
Total Parenteral Nutrition
Extremes of age
Loss of skin integrity (Burns)
Prolonged hospitalization before line insertion.
13
14. Conti..
The femoral central venous catheters are associated
with the highest risk of CLABSI followed by the
internal jugular, and subclavian catheters.
Further
the catheter type
conditions of insertion (emergent versus elective)
use of full barrier precautions versus limited) catheter
care
skill of the operator also influence the risk of CLABSI
14
15. Modifiable Risks
Many CLABSI risk factors can be reduced by careful and consistent use of targeted
prevention practices.
Situation High Risk Low Risk
Insertion Circumstances Emergency Elective
Skill of inserter Novice Specialized
Insertion site Femoral Vein Subclavian Vein
Skin antisepsis 70% alcohol; 10% Povidone-iodine 2% chlorhexidine
Catheter lumens Multi-lumen Single lumen
Duration of catheter use Longer duration Shorter duration
Barrier precautions Submaximal Maximal
15
17. Pathogenesis of CLABSI
Based on route of entry of bacteria:
Extra -luminal:Pathogens migrate along external
surface of catheter from skin entry site Often occurs
within 7 days of insertion.
Intra -luminal: Hub contamination, migration
along internal surface of catheter More commonly
occurs >7 days, intraluminal colonization.
Secondary BSI: Bacteria from another source in
the body infects the blood.
Infusate Contamination:Introduction of pathogens
from fluids infused through the catheter system.
17
18. Examples of counting CL days
Eligible Central Line:
A CL that has been in place for more than two consecutive calendar days (on or
after CL day 3), following the first access of the central line, in an inpatient
location, during the current admission. Such lines are eligible for CLABSI events
and remain eligible for CLABSI events until the day after removal from the body
or patient discharge, whichever comes first.
Oct 30 Oct 31 Nov 1 Nov 2 Nov 3 Nov 4 Nov 5
Patient A CL
Day 3
CL
Day 4
CL
removed
CL
Day 5
CL
Replaced
CL Day 6
CL
Day 7
CL
Day 8
No
Central
Line
Patient B CL
Day 3
CL
Day 4
CL
removed
CL
Day 5
No CL CL
Replaced
CL
Day 1
CL
Day 2
CL Day 3
18
19. Patient has a central line inserted on June 1. On June 3, the central
line is removed and on June 4 the patient has a positive blood
culture with S. aureus
This is a CLABSI because the central line was in place for >2
calendar days (June 1, 2, and 3), and was in place the day before the
date of event (June 4).
Jun 1 Jun 2 Jun 3 Jun 4
CL 1 CL 2 CL 3 No CL CLABSI
CL Removed Culture
positive
19
20. EXAMPLES
A central line is placed in the facility on May 30th. On June 3, the
central line is removed and on June 5 patient spikes a fever of
38.3°C. Two blood culture sets collected on June 6 are positive for
S. epidermidis.
May be a healthcare-associated bloodstream infection but it is not a
CLABSI because the Date of Event (June 5) did not occur on the
day the central line was discontinued (June 3) or the next day (June
4).
May 30 may31 Jun 1 Jun 2 Jun 3 Jun 4 Jun 5 Jun 6
CL1 CL2 CL3 CL 4 CL 5 No CL No CL No CL
CL Removed Fever Spike Blood Culture
positive
20
21. Definitions Specific to BSI / CLABSI
Surveillance:
Primary bloodstream infection (BSI):
A Laboratory Confirmed Bloodstream Infection (LCBI) that is
not secondary to an infection at another body site
Secondary BSI:
A BSI that is thought to be seeded from a site-specific
infection at another body site.
21
22. CLABSI Clinical Definition
CLABSI occurs when these three criteria exist:
Clinical signs of infection
e.g., fever, rigors, altered mental status, hypotension
No alternate source of bloodstream infection
Positive blood culture from a peripheral vein with any one of the
following:
Catheter tip/segment culture that matches organism grown from
blood
At least threefold higher number of organisms grown from the
catheter versus the peripheral blood culture on simultaneously drawn
cultures
22
24. LCBI 1
Patient of any age has a recognized bacterial or fungal
pathogen, not included on the NHSN common
commensal list:
Identified from one or more blood specimens obtained
by a culture OR
AND
Organism(s) identified in blood is not related to an
infection at another site
NHSN COMMENSAL.xlsx
24
25. LCBI 2
Patient of any age has at least one of the following
signs or symptoms:
fever (>38.0oC), chills, or hypotension
AND
Organism(s) identified in blood is not related to an
infection at another site
AND
The same NHSN common commensal is identified by
a culture from two or more blood specimens collected
on separate occasions (see Blood Specimen
Collection).
25
26. LCBI 3
Patient ≤ 1 year of age has at least one of the following
signs or symptoms:
fever (>38.0oC), hypothermia (<36.0oC), apnea, or
bradycardia
AND
Organism(s) identified in blood is not related to an
infection at another site
AND
The same NHSN common commensal is identified by
a culture from two or more blood specimens collected
on separate occasions (see Blood Specimen
Collection).
26
28. Contin….
Patient meets at least one of the following:
1. Is an allogeneic hematopoietic stem cell transplant recipient
within the past year with one of the following documented during
same hospitalization as positive blood specimen:
a. Grade III or IV gastrointestinal graft versus host disease [GI
GVHD]
b. ≥1-liter diarrhea in a 24-hour period (or ≥20 mL/kg in a 24-hour
period for patients <18 years of age) with onset on or within the 7
calendar days before the date the positive blood specimen was
collected.
2. Is neutropenic, defined as at least two separate days with ANC†
and/or WBC values <500 cells/mm3 collected within a 7-day time
period which includes the collection date of the positive blood
specimen, the 3 calendar days before and the 3 calendar days after
28
29. Strategies for Prevention of Catheter-Related
Infections in Adult and Pediatric Patients
1. Education, Training and Staffing
2. Selection of Catheters and Sites
3. Central Venous Catheters Recommendations
4. Hand Hygiene and Aseptic Technique
5. Maximal Sterile Barrier Precautions
6. Skin Preparation
7. Catheter Site Dressing Regimens
8. Administration set change
9. Flushing CVC (INS)
10. Systemic Antibiotic Prophylaxis
11. Anticoagulants
12. Replacement of CVCs, Including PICCs and Hemodialysis Catheters
13. Needleless Intravascular Catheter Systems
14. Performance Improvement
15. 15.Central line-associated bloodstream infection care bundles
29
30. 1.Education, Training and Staffing
Educate healthcare personnel regarding the indications for
intravascular catheter use, proper procedures for the insertion and
maintenance of intravascular catheters, and appropriate infection
control measures to prevent intravascular catheter-related infections
Periodically assess knowledge of and adherence to guidelines for all
personnel involved in the insertion and maintenance of
intravascular catheters
Designate only trained personnel who demonstrate competence for
the insertion and maintenance of peripheral and central
intravascular catheters.
Ensure appropriate nursing staff levels in ICUs. Observational
studies suggest that a higher proportion of “pool nurses” or an
elevated patient–to-nurse ratio is associated with CRBSI in ICUs
where nurses are managing patients with CVCs.
30
31. 2.Selection of Catheters and Sites
Midline Catheter Recommendations
In adults, use an upper-extremity site for catheter
insertion..
In pediatric patients, the upper or lower extremities
or the scalp (in neonates or young infants) can be
used as the catheter insertion site
31
32. 3.Central Venous Catheters Recommendations
Avoid using the femoral vein for central venous access in
adult patients
Use a subclavian site, rather than a jugular or a femoral site,
in adult patients to minimize infection risk for nontunneled
CVC placement
Avoid the subclavian site in hemodialysis patients and
patients with advanced kidney disease, to avoid subclavian
vein stenosis
Use a fistula or graft in patients with chronic renal failure
instead of a CVC for permanent access for dialysis
Use a CVC with the minimum number of ports or lumens
essential for the management of the patient
Promptly remove any intravascular catheter that is no longer
essential
32
33. 4.Hand Hygiene and Aseptic
Technique
Perform hand hygiene procedures, either by washing hands with
conventional soap and water or with alcohol-based hand rubs
(ABHR). Hand hygiene should be performed before and after
palpating catheter insertion sites as well as before and after
inserting, replacing, accessing, repairing, or dressing an
intravascular catheter. Palpation of the insertion site should not be
performed after the application of antiseptic, unless aseptic
technique is maintained
Maintain aseptic technique for the insertion and care of
intravascular catheters
Wear clean gloves, rather than sterile gloves, for the insertion of
peripheral intravascular catheters, if the access site is not touched
after the application of skin antiseptics.
Sterile gloves should be worn for the insertion of arterial, central,
and midline catheters
33
34. 5.Maximal Sterile Barrier Precautions
Use maximal sterile barrier precautions, including
the use of a cap, mask, sterile gown, sterile gloves,
and a sterile full body drape, for the insertion of
CVCs, PICCs, or guidewire exchange.
34
35. 6.Skin Preparation
Prepare skin with 2% chlorhexidine in 70% alcohol using swabs and a
friction scrub for at least 30 seconds s. Do not wipe or blow dry and allow
to dry completely before skin puncture:
30 s for a dry site.
2 min for a moist site (especially femoral).
35
36. 7.Catheter Site Dressing Regimens
Use either sterile gauze or sterile, transparent, semipermeable dressing to cover the
catheter site
Replace catheter site dressing if the dressing becomes damp, loosened, or visibly
soiled
Do not use topical antibiotic ointment or creams on insertion sites, except for
dialysis catheters, because of their potential to promote fungal infections and
antimicrobial resistance
Do not submerge the catheter or catheter site in water. Showering should be
permitted if precautions can be taken to reduce the likelihood of introducing
organisms into the catheter (e.g., if the catheter and connecting device are protected
with an impermeable cover during the shower
Replace dressings used on short-term CVC sites every 2 days for gauze dressings.
Replace dressings used on short-term CVC sites at least every 7 days for
transparent dressings, except in those pediatric patients in which the risk for
dislodging the catheter may outweigh the benefit of changing the dressing
36
37. 8.Administration set change
REPLACEMENT OFADMINISTRATION SETS:
1.In patients not receiving blood, blood products or fat emulsions, replace
adminisration sets that are continuously used, including secondary sets
and add-on devices, no more frequently than at 96-hour intervals.
2. Change intermittent administration set every 24 hours. When an
intermittent infusion is repeatedly disconnected and reconnected for the
infusion , there is increased risk of infection rate.
3.Replace tubing used to administer blood ,blood products , or fat
emulsions(those combined with amino acids and glucose in a 3-in 1
admixture or infused separately) within 24 hours of initiating the infusion.
5. Replace tubing used to administer propofol infusions every 6 or 12
hours or When the vial is changed , per the manufacturer recommendation.
6. No recommendations can be made regarding the length of time a needle
used to access implanted ports can remain in place.
37
38. Given by CDC
Primary continuous Every 96 hours
Secondary Every 96 hours
Primary intermittent Every 24 hours
Secondary intermittent Every 24 hours
TPN Every 24 hours
Lipid emulsion every 24 hours
Blood /blood components after each unit of administration
Propofol infusions Every 6 or 12 hours
38
39. 9.Flushing policy- (INS,Standard 40,
Flushing & Locking, S77).
1.Flush all VADs with preservative-free 0.9% sodium
chloride.
2. Use only preservative-free solutions for flushing all
VADs in neonates to prevent toxicity.
3. Do not use sterile water for flushing VADs.
39
40. 10.Systemic Antibiotic Prophylaxis
1. Do not administer systemic antimicrobial
prophylaxis routinely before insertion or during use
of an intravascular catheter to prevent catheter
colonization or CRBSI.
40
41. 11.Anticoagulants
Do not routinely use anticoagulant therapy to
reduce the risk of catheter-related infection in
general patient populations.
41
42. 12.Replacement of CVCs, Including
PICCs and Hemodialysis Catheters
1. Do not routinely replace CVCs, PICCs,
hemodialysis catheters, or pulmonary artery catheters
to prevent catheter-related infections.
2. Do not remove CVCs or PICCs on the basis of
fever alone. Use clinical judgment regarding the
appropriateness of removing the catheter if infection
is evidenced elsewhere or if a noninfectious cause of
fever is suspected.
42
43. 13. Needleless Intravascular Catheter
Systems
1. Change the needleless components at least as frequently as the administration set.
There is no benefit to changing these more frequently than every 72 hours.
2. Ensure that all components of the system are compatible to minimize leaks and
breaks in the system
3. Minimize contamination risk by scrubbing the access port with an appropriate
antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and
accessing the port only with sterile devices
4. Use a needleless system to access IV tubing.
43
44. 14. Performance Improvement
Use hospital-specific or collaborative-based
performance improvement initiatives in which
multifaceted strategies are "bundled" together to
improve compliance with evidence-based
recommended practices.
44
45. 15.Central line-associated bloodstream
infection care bundles
Central line insertion bundle
Hand hygiene
Wash hands or use an alcohol-based, waterless hand cleaner when caring for central lines:
Before and after palpating the catheter insertion site.
Before and after inserting, replacing, adjusting or dressing the site.
During palpation of the insertion site and after application of antiseptic and only if full asepsis is
maintained.
Complete maximal barrier
The operator inserting the central venous catheter should adhere to strict aseptic techniques
and wear sterile gloves, gown, surgical cap and surgical mask.
Chlorhexidine 2% skin antisepsis
Prepare skin with 2% chlorhexidine in 70% alcohol using swabs and a friction scrub for at
least 30 seconds s. Do not wipe or blow dry and allow to dry completely before skin
puncture:
30 s for a dry site.
2 min for a moist site (especially femoral).
45
46. Conti…
Central line maintenance bundle
Hand hygiene
Practice hand hygiene at five moments33:
Before touching a patient.
Before clean/aseptic procedures.
After body-fluid exposure/risk.
After touching a patient.
After touching patient surroundings.
Aseptic technique for accessing and changing needleless connectors
Scrub the access port or hub immediately prior to each use with an appropriate antiseptic.
Standardised tubing change
Intravenous medication administration tubing should be changed as per the recommendation
in the local organisations policy.
Daily review of catheter necessity
Daily review of line necessity during rounds so that the necessity of the lines can be
determined and unnecessary lines removed.
46
47. Surveillance
1.The CLABSI rate are calculated per 1000 central
line days
CLABSI
rate
As per
CDC/NHSN
definition
Number of CLABSI in a
month
______________________
No.of Central line days in
that month
X 1000
/ 1000
Central
Line days
Monthly
47
53. Conclusion
Successful implementation of evidence-based interventions can lead to
dramatic and sustained reductions of CLABSIs in hospital ICUs
Clinician education
Skill Competency Of Clinician Who performs CVC need to assessed
privileging of Clinicians
Designated Physician and Nursing Team Leader
Central-line cart in each ICU
Insertion Checklist with BUNDLE care
Nurse empowerment to stop procedure if best practices are not followed
Empowering Infection control Nurses/Link Nurses on capturing HAI
Adherence to best clinical practices
To frontline staff, feedback provided regarding rates of CLABSI
53
54. Take home message
Wash Hands.
Use Aseptic Precautions.
Follow BUNDLE care Approach.
54
55. References
CDC (Central Disease Control and Prevention)
AHRQ (Agency for Healthcare Research and Quality)
AIIMS, New Delhi
Joint Commission
NHSN (National Healthcare Safety Network)
INS (Infusion Nurses Society)
NABH 5th Edition
55