Blood Stream Infections (BSI) in your unit

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Specializes in critical care, trauma, neurosurgery..

We have recently had a spike in the number of BSI's in our Trauma unit. We have implemented several changes to reduce the bsi's but we have not seen much of a change. Currently, we bathe all patients with a central line in Hibiclens with disposable wipes, we have a trained team to perform dressing changes on the lines, and we have of course been following standards like scrubbing the hub for 15 seconds. What are some methods that some of y'all have been using to prevent bsi's?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Welcome to AN and the new trauma forums!!! AN is the largest online nursing community.

I have seen some recent studies heavily linked to the hubs on certain tubing system with residual blood in the hub of the line being heavily to BSI.

What type of tubing do you use? It was heavily linked to the "clave" type systems.

Great article.

http://www.zerobsi.com/bsi/pdf/11_09ICT_CareFusion_elec.pdf

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Specializes in Trauma Surgical ICU.

My current trauma unit hasn't had a BSI in more than a year. We wash all pts with soap and water daily. The dressing to all central lines are changed 24 hours post insertion and a bio batch is applied at the insertion site. Dressing are then changed PRN or q7 days. Caps are changed after all blood draws, q7days and we us clori-prep to access all ports. The caps on our lines are clear so you can "see" the inside. I am sorry, I do not know the name of them to provide a link for you. We also piggy back most of our fluids in so we don't have the access the ports as often. Any one of us can change the dressing, so we don't do anything usual there but follow sterile technique.

In addition to the things we normally do, all TLC's are changed to PICC's after 7 days. Any groin line is removed after 24 hours or sooner..

I am in the process of leaving my current unit to go to another trauma unit who is also having an increase in BSI, I have a sample of our bio patch and caps as well as our infection control data to show them. Im not sure if your unit has a lot of new nurses; that could be contributing to the increase. Might be something to look into.

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Specializes in critical care, trauma, neurosurgery..

Our unit does have several new nurses, including myself. Our director and educational department have been trying several different methods, but the BSI's are still popping up. I am not sure if we use a Bio patch on our lines or not. I like the idea of using Chlori-prep to access the port. Do you use Chlori-prep wipes or the chlori-prep scrubbers?

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Specializes in ER/ICU/STICU.

A new thing my unit has implemented the use of curos caps.

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Specializes in Trauma Surgical ICU.

We use the wipes before accessing the ports and the sticks to clean to site at each dressing change. The bio patch is a round disk that goes over the cath at the insertion site.

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The docs need to change the lines every 7 days

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Specializes in Trauma ICU.
Our unit does have several new nurses, including myself. Our director and educational department have been trying several different methods, but the BSI's are still popping up. I am not sure if we use a Bio patch on our lines or not. I like the idea of using Chlori-prep to access the port. Do you use Chlori-prep wipes or the chlori-prep scrubbers?

How do you not know if your unit uses the Bio patch...

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Specializes in NICU, PICU, PACU.

Most line infections are caused by people improperly accessing the line or less than sterile technique putting them in. Our SICU changes all dressings that are done on the ER and places bio discs as soon as they can.

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We use Curos caps on all our central lines in combo with the clear caps and ever since making the change hospital-wide we haven't had a single CLAB in over a year. :) Those Curos caps are life-changers, but they are approximately $0.25 a piece ($60 a box) and they are one-time use. We also do the general strict sterile technique with dressing changes Q 7 days and the tegaderms we use on our dressing changes have a chlorahexidine-impregnated gel in the center that is placed directly over the catheter insertion site.

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Specializes in ER, progressive care.
My current trauma unit hasn't had a BSI in more than a year. We wash all pts with soap and water daily. The dressing to all central lines are changed 24 hours post insertion and a bio batch is applied at the insertion site. Dressing are then changed PRN or q7 days. Caps are changed after all blood draws, q7days and we us clori-prep to access all ports. The caps on our lines are clear so you can "see" the inside. I am sorry, I do not know the name of them to provide a link for you. We also piggy back most of our fluids in so we don't have the access the ports as often. Any one of us can change the dressing, so we don't do anything usual there but follow sterile technique.

In addition to the things we normally do, all TLC's are changed to PICC's after 7 days. Any groin line is removed after 24 hours or sooner..

I am in the process of leaving my current unit to go to another trauma unit who is also having an increase in BSI, I have a sample of our bio patch and caps as well as our infection control data to show them. Im not sure if your unit has a lot of new nurses; that could be contributing to the increase. Might be something to look into.

My unit pretty much utilizes all of these practices and each year we have zero BSIs. We don't use chloriprep to access ports, though, just an alcohol swab.

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Specializes in Trauma, Critical Care.

"Scrub the hub" for 15 seconds with alcohol, change IV tubing and caps q4days unless it's propofol (q12 hours), change central line dressings q7days unless there is a gauze over the insertion site then the gauze must be removed within 24 hours.

How is your units hand washing compliance?

How do you draw cultures? Assuming you know they aren't coming back just contaminated.

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