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Lining Up to Reduce CLABSIs

Created Nov 01 2018, 02:42 PM by Lippincott Solutions
  • CLABSI
  • HAI
  • patient safety
  • Medicare reimbursement
  • National Patient Safety Goals
  • healthcare quality
  • CDC

Central line-associated bloodstream infections (CLABSIs) are the #1 most costly type of hospital-acquired infection (HAI) and pose serious consequences for both patients as well as hospitals.  Consider these stark CLABSI statistics:

  • Over 30,000 incidences occur annually throughout the U.S.
  • A typical CLABSI diagnosis increases length-of-stay (LOS) by 7 days and each case results in an average of $46k in additional costs
  • Increases patient mortality risk by 12-25% (more than twice as much as patients without CLABSI)

As a major threat to the health of patients and the reputation of hospitals, organizations must take measures to prevent these infections. And nurses are on the front line.

CLABSIs occur when bacteria or viruses enter the bloodstream through a central venous catheter (CVC), which is often placed in a large vein in the neck, chest, or groin to administer 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.

CHECKLIST FOR PREVENTION

The Centers for Disease Control (CDC), in collaboration with other organizations, has developed a checklist for the prevention of CLABSI and other types of healthcare-associated infections. Facilities can monitor the rates of CLABSI and assess the effectiveness of prevention efforts through CDC’s National Healthcare Safety Network (NHSN).

Follow proper insertion practices.

  • Perform hand hygiene before insertion.
  • Adhere to aseptic technique.
  • Use maximal sterile barrier precautions (mask, cap, gown, sterile gloves, and sterile full body drape).
  • Choose the best insertion site to minimize infections and noninfectious complications based on individual patient characteristics. Avoid femoral site in obese adult patients.
  • Prepare the insertion site with >0.5% chlorhexidine with alcohol.
  • Place a sterile gauze dressing or a sterile, transparent, semipermeable dressing over the insertion site.
  • For patients 18 and older, use a chlorhexidine impregnated dressing with an FDA cleared label that specifies a clinical indication for reducing CLABSI for short term non-tunneled catheters unless the facility is demonstrating success at preventing CLABSI with baseline prevention practices.

Handle and maintain central lines appropriately.

  • Comply with hand hygiene requirements.
  • Bathe ICU patients over 2 months of age with a chlorhexidine preparation on a daily basis.
  • Scrub the access port or hub with friction immediately prior to each use with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol).
  • Use only sterile devices to access catheters.
  • Immediately replace dressings that are wet, soiled, or dislodged.
  • Perform routine dressing changes using aseptic technique with clean or sterile gloves. Change gauze dressings at least every two days or semipermeable dressings at least every seven days. For patients 18 years of age or older, use a chlorhexidine impregnated dressing with an FDA-cleared label that specifies a clinical indication for reducing CLABSI for short-term non-tunneled catheters unless the facility is demonstrating success at preventing CLABSI with baseline prevention practices.
  • Change administration sets for continuous infusions no more frequently than every 4 days, but at least every 7 days. If blood or blood products or fat emulsions are administered change tubing every 24 hours. If propofol is administered, change tubing every 6-12 hours or when the vial is changed.
  • Promptly remove unnecessary central lines. Perform daily audits to assess whether each central line is still needed.

In addition, everyone visiting the patient must wash their hands—before and after they visit.

ORGANIZATION-WIDE EFFORT

  • Educate healthcare personnel about indications for central lines, proper procedures for insertion and maintenance, and appropriate infection prevention measures.
  • Designate personnel who demonstrate competency for the insertion and maintenance of central lines.
  • Periodically assess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of central lines.
  • Provide a checklist to clinicians to ensure adherence to aseptic insertion practices.
  • Reeducate personnel at regular intervals about central line insertion, handling and maintenance, and whenever related policies, procedures, supplies, or equipment changes.
  • Empower staff to stop non-emergent insertion if proper procedures are not followed.
  • Ensure efficient access to supplies for central line insertion and maintenance. Create a bundle with all needed supplies.
  • Use hospital-specific or collaborative-based performance measures to ensure compliance with recommended practices.

Nurses can lead the way in taking the appropriate measures to lessen the threat of CLABSIs.

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