1. Measures to Prevent Central Line Associated Bacteremia In the ICU Candace Anglea, RN, CIC Infection Control Practitioner

2. Demographics 541 bed acute care facility Average daily census 275+
A member of STHS – 4 hospital system
-STH, Baptist, MTMC, Baptist Hickman
Over 10,000 employees systemwide
Primary services include:
- Cardiac, Orthopedic, Neurosurgery,
Oncology
One Infection Control Practitioner!!

3. Saint Thomas ICU’s Pods- 40 beds 5 Pods- 8 beds per pod
*Average 650 line days per month
Special Care Units-
60 beds
*Average 500 line days per month
*Approximately 1,000 ICU line days per month

4. ICU staffing Intensivists- Physicians board certified in
Anesthesia and Critical Care Medicine
Only Intensivists insert and change lines-
no residents
Lines are routinely changed q 4 days-
(does not include PICC’s)
Critical Care Nurse Practitioners-
(Both Cardiac and Med/Surg)
RN’s and Support Staff

5. Standardized Line Carts
Standardized line carts are kept in designated areas with frequent line insertions-
Pods
Special Care Units
Holding rooms OR ER

6. Central Line Insertion Checklist
Developed and implemented August 2007
Forms are kept on top of line carts for RN
who assists with procedure to fill out at the
time of insertion
Infection Prevention picks forms up weekly
Data reviewed for trends-
Max barrier precautions, hand hygiene, etc.

7. Maximal Barrier Precautions
Currently central line kits are not inclusive
Gowns, hats, masks, are kept on carts but
pulled as separate items
Chloraprep not in all kits but kept on cart
Drape- do not currently use a full body
head to toe drape
Looking at drape options currently

8. Challenges Implementation of full body drape
Implementation of safe sharp devices to meet
OSHA requirements
2 different OR’s- Cardiac and Main OR
2 different anesthesia groups
Different practices- one group uses drape in
kits; other group uses sterile towels
Site selection approximately 50/50 for
Subclavian vs IJ
IJ’s placed for convenience at times

9. Successes Intensivists play a critical role
Daily assessment of patients with lines
during ICU rounds
Very actively engaged in Infection
Prevention- Chief of Anesthesia on ICC
Proud of sustained low BSI rates
BSI rate at zero > 2 years!

10. PICC lines Inserted by IV Therapy Team
Radiology inserts PICC’s if IV therapy not
successful
Have recently implemented Maximal Barrier
Kits with all PICC insertions
Safety needles used
Challenges with dressing/site care not
always done per policy
Majority of BSI infections are r/t PICC’s

11. Dressing Changes/Site Care Protocols
All Central Line Dressings q 96 hours &
PRN
All PICC Line Dressings q 7 days and PRN
All IV tubing changes q 96 hrs- exceptions
for blood, TPN, Lipids, other lipid solutions
Use CHG for all dressing changes/PIV’s
All ports to be cleaned with alcohol wipe
before use

12. Questions?
Contact Information:
Thank You!

13. Dressing Changes/Site Care Protocols
All Central Line Dressings q 96 hours &
PRN
All PICC Line Dressings q 7 days and PRN
All tubing changes q 96 hrs
Use CHG for all dressing changes/PIV’s
All ports to be cleaned with alcohol wipe
before use