CLABSI issues

[MoeNoons, BSN, MSN]

Hi all,

This is a question regarding CLABSI prevention.

• What have you/your facility implemented to decrease CLABSIs?
• How are you tracking that CVC line maintenance procedures are being followed?
• Do you use CHG baths?
• Do you have a policy/practice about use of the femoral artery?

My asking deals with a group of CLABSIs that have occurred and when I investigated them, I found no commonalities among them.

I am looking for ideas to bring to committee.

Thank you!

MoeNoons

[Flatline, BSN, RN]

Some additional questions to consider:

• Were these CLABSI or CRBSI? Do you know if these were actually related to the catheter or was a central catheter just present?
• Were there any PIVs in place with these patients?
• Were they intraluminal or extraluminal infections?
• Was this a spike above baseline?
• Who does the dressing changes? When was the last time there was a training effort for dressing changes?

Dr. Eggimann just published a MASSIVE 11 year catheter associated BSI reduction study in Intensive Care Med that is interesting. 18k patients, 155k catheter-days, 91k ICU days.

[Nunya, BSN]

So....all I can answer, and probably only partially for your use, is when I worked NICU at a Texas hospital for about 6 months in 2013. They had a problem with this and developed an IV team (though the nurses on the team also did patient care on some if their shifts). Only RNs on the team could change tubing on central lines, do dressing changes or set up antibiotics or other meds that were going through a central line. They gowned and gloved and I think wore face masks for this. They were in teams of two and one did the charting and opened supplies and the other did the tubing change etc. Interestingly anyone could do the initial tubing setup for umbilical lines. Anyway, they decreased their infection rate to ZERO. And it was nice for the nurses because this was one big chore they didn't have to do, other than gathering the supplies and checking TPN (though it was also checked by the team). The majority of the time they didn't have a patient care assignment as the unit had about 60ish beds, but they were available to look at IV sites and I think they would help start IVs prn.

[iluvivt, BSN, RN]

Some more things to consider: 1.Have the nurses been faithfully changing the needless connectors at least every 7 days and when compromised. Have they been covering the ports and NCs with alcohol impregnated caps and if not having they been scrubbing them. Hub manipulation ,especially on long term CVADs, is a common source of infection. 2. Are all your providers using max barrier for all insertions. 3.What type of CVADs were these..any PICCs. Where were they placed...all ICU...ED..etc? You need to look at insertion based prevention and well as use based prevention strategies.

[NICU Guy, BSN, RN]

Our Central line policy is:

• sterile tubing change every 5 days for continuous drips excluding Lipids.
• sterile Lipid tubing change every 24 hours
• Central line dressing change every 7 days or when line in no longer occlusive.
• CHG baths twice a week

We are at 430 days and counting of no CLABSI in our unit.