Blood Stream Infections

LIZPICURN · May 25, 2006

In my large PICU unit they have done a lot to decrease blood stream infections. For example with central lines, all meds are wired in with your MIVF. If you need to replace an empty syringe for a full dose you use alcohol and don gloves. If you ever need to break into the line a mask, sterile gloves, and chlorhexidine scrub is utiized. (30 second scrub). Dressing changes are every 3 days and we use a chlorhexidine patch. cap changes are every 3 days or within 24 hours after blood products are administered. I have travelled for a few years and this hospital has remarkablly lower rates that other hospitals I have travelled to.

TennRN2004 · May 26, 2006

I can't tell you off the top of my head what our bloodstream infection rates are, but I know they're good. We prevent blood infection in many ways including silver impregnated central lines, biopatch to central line insertion site, policy of sterile dressing changes, wearing gloves when touching central line for meds/flushes, preventing VAP in vent patients using the VAP bundle-HOB 30 degrees, q2 oral care, GI ucler/DVT prophylaxis, good skin care to prevent decubitus from causing another route of potential infection, and wound nurse consults for wounds, keeping close eye in s/s infection for fast treatment by MDs, frequent hand washing, signs for patients with transmittable organisms (C Diff, MRSA, etc.) and could keeping going for a day or so...But, what many people don't consider is that while prevention is crucial, many patients come in either with a bloodstream infection already, or with a nasty UTI or pnemonia that can easily become sepsis very quickly. Unfortunately, we cannot ever prevent all cases of sepsis for this reason, and for the reason that hospital patients are exposed to super bugs in the hospital in spite of our best efforts, their immune systems are compromised, they're being treated on multiple antibiotics to set them up for resistant infections, and because they come in sick in the first place.

cvryder · May 27, 2006

.But, what many people don't consider is that while prevention is crucial, many patients come in either with a bloodstream infection already, or with a nasty UTI or pnemonia that can easily become sepsis very quickly. Unfortunately, we cannot ever prevent all cases of sepsis for this reason, and for the reason that hospital patients are exposed to super bugs in the hospital in spite of our best efforts, their immune systems are compromised, they're being treated on multiple antibiotics to set them up for resistant infections, and because they come in sick in the first place.

Boy oh boy, does that hit home! I would say most of our septic patients come in that way. Like we could prevent that, when they don't even get to ER without being septic in the first place! Nursing home patients are particularly bad.

One thing I question that is done in the ICU where I am a traveler is the practice of hitting a patient with a one-time dose of Vancomycin, without even waiting for cultures to come back. Looks to me like that might set up more Vanc-resistant bugs. Correct me if I'm wrong?

Jilly

TennRN2004 · May 31, 2006

Boy oh boy, does that hit home! I would say most of our septic patients come in that way. Like we could prevent that, when they don't even get to ER without being septic in the first place! Nursing home patients are particularly bad.
One thing I question that is done in the ICU where I am a traveler is the practice of hitting a patient with a one-time dose of Vancomycin, without even waiting for cultures to come back. Looks to me like that might set up more Vanc-resistant bugs. Correct me if I'm wrong?
Jilly

We usually give a dose of a broad spectrum antibiotic after we've drawn

blood ,urine, and sputum cultures. Then, when the specifics of the culture come back, we'll switch to what the bug is sensitive to. I think the current Surviving Sepsis guidelines recommend treating this way, but it's been a while since I've read the data. I work in an SICU now instead of a MICU and we don't see septic patients as much.