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CENTRAL LINE

ASSOCIATED
BLOODSTREAM
INFECTIONS.
Karen Padilla, BSN, RN
Victoria Ramos-Avila, BSN, RN

Background

Central Lines are placed in the major veins that are close to the
heart and are placed for a long term use therapy, hemodynamic
monitoring and infusion of vesicant agents.

Central Associated Bloodstream Infection occurs when bacteria


or viruses enter the blood stream through the mentioned
catheters.

There are several components that need to be tested in order to


prove that a blood stream infection is an actual CLABSI.

Numbers and Statistics.

According to American Journal of Infection Control (2014) An


estimated of 2 million patients acquire Health care associated
infections every year in the US.

CDC accounts for 30,100 CLABSIs in the United States ICUs each year.

CLABSI infections are associated with a mortality rate as high as 25 %


(American Journal of Infection Control, 2014).

According to American Journal of infection control, approximately 12


days may be added to hospitalization stay for each patient that
acquired a CLABSI (2014).

Objectives and Goals

Reduce incidence of CLABSIs in the ICU setting.

Educate nurses on current guidelines and Evidence


Based Practices to prevent CLABSIs.

Avoid using femoral vein for central line if possible.

Emergent central line should be removed 24 to 48


hours after placement, and be replaced in new site.

To reduce CLABSIs, remove central Venous catheters


when no longer necessary.

National Patient Safety Goals


2015
Goal 7: Reduce the risk of health care-associated
infections.

NPSG 07.01.01 Comply with the current CDC hand


hygiene guidelines or the current World Health
Organization guidelines.

NPSG.07.03.01 Use proven guidelines to prevent


infections that are difficult to treat.

NPSG.07.04.01 Use proven guidelines to prevent


infection of the blood from central lines.

Evidence Based Practice


According to the Central for Disease Control and
Prevention and American Journal of Infection control the
best practices in reducing CLABSI include de following.

Recommended Central Line insertion Practices:

Hand hygiene by everyone involved with placement


and patient care.

Apply appropriate skin antiseptic

Skin prep has to be dry before inserting the catheter.

Use all five sterile barrier precautions: sterile gloves,


sterile gown, cap, mask, large sterile drape.

Continue

Follow recommended Central Line maintenance:

Change dressing every 7 days or when soiled.

Use sterile technique when changing dressing.

Clean site with chlorhexidine prep preferably.

Use biopatch every time you put a new dressing.

Flush central line ports with 5 cc NS at least once a shift.

Remove central line as soon as possible.

Change femoral and emergent lines 24-48 hours after placement


if possible to a new site.

Current Local Data

CLABSI 2014
3.5
3

3
2.5
2

1.5
1

0.5
0

jan-march

apri-jun
SICU

MICU

july- sept

Implementation

Educate Intensive Care nurses on proper documentation on


Central Line insertion, maintenance and removal via CERNER,
clip form/flow sheet.

Educate ICU nurses on Evidence Base Guidelines


recommendations for insertion, maintenance and removal in
order to reduce CLABSI rates

In order to prevent CLABSI we will be monitoring compliance with


guidelines.

Central Line rounds will take place every week.

Assistant personnel will be included at the time of central line


maintenance.

Outcomes

Intensive Care nurses will be aware of proper documentation on


Central Line insertion, maintenance and removal via CERNER,
clip form/flow sheet.

ICU nurses will practice Evidence Base Guidelines


recommendations for insertion, maintenance and removal in
order to reduce CLABSI rates

Confidence interval will indicate about the same or less as the


national experience for Med-Surg ICU

Confidence interval will indicate about the same or less as the


national experience for UMC trauma ICU.

CLABSI numbers will be reduce 25% after proper education and


implementation of Evidence Base Practice by the end of the
fourth quarter of 2015

References
Central Line-associated Bloodstream Infection (CLABSI). (2012, May 17).
Retrieved May 5, 2015, from http: //www.cdc.gov/HAI/bsi/bsi.html
OGrady,AlexanderM,DellingerEP,GerberdingJL. (2012, April) Guidelines for
the prevention of intravascular catheter-related infections. Centers for
Disease Control and Prevention.
Preventing bloodstream infections from central line venous catheters.
(n.d.). Retrieved May 5, 2015, from
http://www.who.int/patientsafety/implementation/bsi/en/
The Joint Commission. (n.d.). Retrieved May 5, 2015, from
http://www.jointcommission.org/hap_2015_npsgs/default.aspx
Thomb, K., Custer, M., & Rew, C. (2013, March 1). Successful
Implementation of a Unit-Base quality Nurse to Reduce Central Line
associated bloodstream Infection