Central line-associated bloodstream infections (CLABSI) occur when bacteria or viruses enter the bloodstream through a central venous catheter, which is often placed in a large vein in the neck, chest, or groin to give medication or collect blood for medical tests. Because central lines access a major vein and can remain in place for weeks or months, they are much more likely to cause serious infection.
CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable. The Centers for Disease Control (CDC) and U.S. Department of Health & Human Services provides guidelines and tools to the healthcare community to help end CLABSIs.
Healthcare providers should follow recommended central line insertion practices to prevent infection when the central line is placed, including:
Here are some ways patients can protect themselves from CLABSI:
In ddition, everyone visiting the patient must wash their hands—before and after they visit.
The Agency for Healthcare Research and Quality has made available tools that will help ICUs implement evidence-based practices and eliminate CLABSI. When used with the CUSP (Comprehensive Unit-based Safety Program) Toolkit, these tools dramatically reduced CLABSI rates in more than 1,000 hospitals across the country.
The infection prevention tools are based on four principles in the CUSP toolkit:
1.Engage. First make the CLABSI problem real by identifying a patient on your unit who suffered needless harm from a CLABSI and share that patient's story with your colleagues. Ask them if this is the kind of care they would want for their family, if this is care they are proud of, and if this is the best your unit can do.
Post the number of patients who developed a CLABSI and the total number of CLABSI cases for the previous year on your unit. Post a trend line so nurses and physicians can see at a glance the unit's CLABSI rate and how it changes over time. Post the number of days (or weeks or months) since the unit's last CLABSI. Use formal and informal opportunities to talk about the intervention and about unit-specific infection rates. Raising awareness among unit staff members of evidence-based practices will help eliminate CLABSI.
2.Educate. Make sure your staff members understand how they can reduce CLABSI. Numerous interventions have reduced the incidence of CLABSI and the ensuing morbidity, mortality, and costs. In addition, the CD), the Society of Critical Care Medicine, the Society of Healthcare Epidemiologists of America (SHEA), the Infectious Disease Society of America (IDSA), and several other organizations have developed evidence-graded guidelines to prevent catheter-related infections. Several of the guideline recommendations are supported by clinical trials or systematic reviews.
3.Execute. Implement a checklist. Creating independent redundancies through the use of a checklist is an effective technique to monitor whether or not providers adhere to care processes. Some organizations require a nurse to be present bedside during all central line insertions and to complete a checklist during every central line insertion. Using a checklist allows nurses to serve as an independent, redundant check to encourage physician adherence to evidence-based practices.
Pilot test the checklist on your unit for one week and interview several nurses regarding the form's clarity, the data collection burden, and any needed modifications.
Nurses can help in the effort to prevent and reduce CLABSIs by identifying best practices and opportunities for improvement, which enhance the facility's overall safety culture.
4.Evaluate. The first step in evaluating the success of CLABSI prevention efforts is to collect unit baseline CLABSI rates for the past 12 months. Next track unit CLABSI rates over time. Enter your data into a state-level database or the CDC's National Healthcare Safety Network. Although all units are urged to adopt the CDC's standardized definitions for CLABSI, definitions may still vary among hospitals. As long as your definition of a CLABSI remains constant, you can evaluate trends over time in infection rates.
And lastly, be sure to communicate your results with the entire team, patients and their families.
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