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

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Presentation on theme: "Measures to Prevent Central Line Associated Bacteremia In the ICU Candace Anglea, RN, CIC Infection Control Practitioner."— Presentation transcript:

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

2 541 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!! Demographics

3 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 Saint Thomas ICUs

4 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 PICCs) Critical Care Nurse Practitioners- (Both Cardiac and Med/Surg) RNs and Support Staff ICU staffing

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

6 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. Central Line Insertion Checklist

7 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 Maximal Barrier Precautions

8 Implementation of full body drape Implementation of safe sharp devices to meet OSHA requirements 2 different ORs- 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 IJs placed for convenience at times Challenges

9 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! Successes

10 Inserted by IV Therapy Team Radiology inserts PICCs 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 PICCs PICC lines

11 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/PIVs All ports to be cleaned with alcohol wipe before use Dressing Changes/Site Care Protocols

12 Thank You! Questions? Contact Information:

13 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/PIVs All ports to be cleaned with alcohol wipe before use Dressing Changes/Site Care Protocols


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