Presentation on theme: "Measures to Prevent Central Line Associated Bacteremia In the ICU Candace Anglea, RN, CIC Infection Control Practitioner."— Presentation transcript:
1Measures to Prevent Central Line Associated Bacteremia In the ICU Candace Anglea, RN, CIC Infection Control Practitioner
2Demographics 541 bed acute care facility Average daily census 275+ A member of STHS – 4 hospital system-STH, Baptist, MTMC, Baptist HickmanOver 10,000 employees systemwidePrimary services include:- Cardiac, Orthopedic, Neurosurgery,OncologyOne Infection Control Practitioner!!
3Saint Thomas ICU’s Pods- 40 beds 5 Pods- 8 beds per pod *Average 650 line days per monthSpecial Care Units-60 beds*Average 500 line days per month*Approximately 1,000 ICU line days per month
4ICU staffing Intensivists- Physicians board certified in Anesthesia and Critical Care MedicineOnly Intensivists insert and change lines-no residentsLines 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
5Standardized Line Carts Standardized line carts are kept in designated areas with frequent line insertions-PodsSpecial Care UnitsHolding roomsORER
6Central Line Insertion Checklist Developed and implemented August 2007Forms are kept on top of line carts for RNwho assists with procedure to fill out at thetime of insertionInfection Prevention picks forms up weeklyData reviewed for trends-Max barrier precautions, hand hygiene, etc.
7Maximal Barrier Precautions Currently central line kits are not inclusiveGowns, hats, masks, are kept on carts butpulled as separate itemsChloraprep not in all kits but kept on cartDrape- do not currently use a full bodyhead to toe drapeLooking at drape options currently
8Challenges Implementation of full body drape Implementation of safe sharp devices to meetOSHA requirements2 different OR’s- Cardiac and Main OR2 different anesthesia groupsDifferent practices- one group uses drape inkits; other group uses sterile towelsSite selection approximately 50/50 forSubclavian vs IJIJ’s placed for convenience at times
9Successes Intensivists play a critical role Daily assessment of patients with linesduring ICU roundsVery actively engaged in InfectionPrevention- Chief of Anesthesia on ICCProud of sustained low BSI ratesBSI rate at zero > 2 years!
10PICC lines Inserted by IV Therapy Team Radiology inserts PICC’s if IV therapy notsuccessfulHave recently implemented Maximal BarrierKits with all PICC insertionsSafety needles usedChallenges with dressing/site care notalways done per policyMajority of BSI infections are r/t PICC’s
11Dressing Changes/Site Care Protocols All Central Line Dressings q 96 hours &PRNAll PICC Line Dressings q 7 days and PRNAll IV tubing changes q 96 hrs- exceptionsfor blood, TPN, Lipids, other lipid solutionsUse CHG for all dressing changes/PIV’sAll ports to be cleaned with alcohol wipebefore use
13Dressing Changes/Site Care Protocols All Central Line Dressings q 96 hours &PRNAll PICC Line Dressings q 7 days and PRNAll tubing changes q 96 hrsUse CHG for all dressing changes/PIV’sAll ports to be cleaned with alcohol wipebefore use