1. Preventing Central Line-Associated Bloodstream Infection (CLABSI) at Community Medical Center

2. Background
250,000 Central Veneous Catheter (CVC) related blood stream infections occur in the United States each year, with a mortality of 12% to 25% per infection
30,000 to 48,000 patients die each year as a result of CLABSI’s-That’s 248 plane crashes a year
Each CLABSI cost an average of $3,700 to $25,000
Increasing the length of hospital stay by an average of 7 days.

3. Background continued For 2008 CMC had 9 central line infections.
That is 9 to many
Do you want one of your family members to be one of those 9?

4. Risk Factors Prolonged hospitalization before catheterization
Prolonged duration of the catheterization
Internal jugular catheterization
Femoral catheterization
Environment: Bacteria lives on walls, floors, side bed rails…
Microbial colonization at insertion site
Microbial colonization of the
catheter hub

5. CMC is raising the bar
Nationwide efforts are trying to reduce preventable deaths in hospitals and CMC is in the fore front of this initiation
One of the ways identified to help reduce central line associated bloodstream infections (CLABSI) is by “Bundling” our central line procedure.
Bundling is taking 3-5 evidenced based practices or precautionary steps and put them together and implementing them together
When all of the practices/precautionary steps are done together the results equal improved quality patient care

6. Central line Bundling
The Central Line Safety Checklist & The Central Line Maintenance Sheet is attached to the central line insertion kit
Use it for central line insertion and maintenance
Fax both sheets after insertion to Infection , then turn it in to your manager
Hand Hygiene
Wash hands before donning on gloves and after procedure

7. Central line bundle continued
Maximal Barrier Precautions
New Central Line Supplement kit will be used in addition to the central line insertion kit
It will include sterile: cap (2), gown (2), mask (2), medication labels, Chlorhexidine swab (1), central line SorbaView Securement dressing (1), and a Biopatch (1)
Cover patient head to toe with the fenestrated section at the insertion site
The subclavian is the optimal insertion site (femoral and jugular is not recommended by CDC, it increases the risk of infection.)
Physician and assistant: Wear cap, gown, sterile gloves and mask.
After insertion:
Place Biopatch at insertion site, then secure with the SorbaView Securement dressing
Do not suture central line in patient
It increases patient discomfort and increase risk for infection

8. Chlorhexidine
The formulation of 2% CHG and 70% Isopropyl alcohol. They work together to provide the most rapid and persistent antimicrobial activity on the skin surface and acts fast on a broad spectrum of bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), and keeps fighting bacteria for at least 48 hours. It supports infection control guidelines for helping to reduce the incidence of blood stream infections
To use
Pinch the wings on the swab and release
Gently press the sponge against the treatment area
Apply friction rub for 30 seconds on the upper torso and allow to dry for 30 seconds
For lower torso rub for 2 minutes and allow to dry for 1 minute
Important Reminder
Do not use on pediatrics weighing less than 1000 grams and do not use on pediatrics who do not have good skin integrity

9. Biopatch Precautions: Benefits: Important points to remember:
Broad Spectrum antimicrobial and antifungal agent
Continually releases chlorhexidine gluconate for 7 days
Absorbs up to 8 times it’s own weight
BIOPATCH is proven to reduce CLABSI’s by 60% in patients with central venous catheters
Precautions:
Do not use on pediatrics weighing less than 1000 grams and do not use on pediatrics who do not have good skin integrity
Do not place on infected wounds. It is not intended to be used as a treatment of percutaneous infections
Important points to remember:
PLACE SHINY SIDE UP
To be used on all central line insertions and changed when dressing change occurs (EVERY 7 DAYS)

10. Securement Dressing Do not suture central line into patient as this :
Increases patient discomfort
Increases risk for infection
Suturing increases risk of needle stick
Change Securement dressing every 7 days(use central line dressing change kit)

11. Daily Review of Central line
Document on Central line flowsheet
Central line insertion date
Daily assessment of insertion site (each shift)
Evaluate all central lines daily with physician and remove nonessential lines
We are all an essential piece in preventing infections.
Help out patients get the best quality care here at CMC and be a role model to other hospitals
References:
CDC, 1000 Lives Campaign
Institute for Healthcare Improvement: Implement the Central Line /IHI/Topics/Critical Care/intensive Care/Changes, last accessed 4/09
Society of Healthcare Epidemiology of America , Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals 2008
Last accessed 4/09
PP by Scappel 09

12. References CDC, 1000 Lives Campaign
Institute for Healthcare Improvement: Implement the Central Line Care/intensive Care/Changes last accessed 4/09
Society of Healthcare Epidemiology of America , Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals 2008
hhtp:// Last accessed 4/09
PP by Scappel/Jshaw 09