1. ICU TO PREVENT CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS.
Karen Padilla, BSN, RN
Victoria Ramos-Avila, BSN, RN

2. Backround
Central Lines are placed in the major veins that are close to the heart and are placed for a long term use therapy, hemodynamic monitoring and infusion of vesicant agents.
Central Associated Bloodstream Infection occurs when bacteria or viruses enter the blood stream through the mentioned catheters.
There are several components that need to be tested in order to prove that a blood stream infection is an actual CLABSI.

3. Numbers and Statistics.
According to American Journal of Infection Control (2014) An estimated of 2 million patients acquire Health care associated infections every year in the US.
CDC accounts for 30,100 CLABSIs in the United States ICUs each year.
CLABSI infections are associated with a mortality rate as high as 25 % (American Journal of Infection Control, 2014).
According to American Journal of infection control, approximately 12 days may be added to hospitalization stay for each patient that acquired a CLABSI (2014).

4. Objectives and Goals
Reduce incidence of CLABSIs in the ICU setting.
Educate nurses on current guidelines and Evidence Based Practices to prevent CLABSIs.
Avoid using femoral vein for central line if possible.
Emergent central line should be removed 24 to 48 hours after placement, and be replaced in new site.
To reduce CLABSIs, remove central Venous catheters when no longer necessary.

5. National Patient Safety Goals 2015
Goal 7: Reduce the risk of health care-associated infections.
NPSG Comply with the current CDC hand hygiene guidelines or the current World Health Organization guidelines.
NPSG Use proven guidelines to prevent infections that are difficult to treat.
NPSG Use proven guidelines to prevent infection of the blood from central lines.

6. Evidence Based Practice
According to the Central for Disease Control and Prevention and American Journal of Infection control the best practices in reducing CLABSI include de following.
Recommended Central Line insertion Practices:
Hand hygiene by everyone involved with placement and patient care.
Apply appropriate skin antiseptic
Skin prep has to be dry before inserting the catheter.
Use all five sterile barrier precautions: sterile gloves, sterile gown, cap, mask, large sterile drape.

7. Continue… Follow recommended Central Line maintenance:
Change dressing every 7 days or when soiled.
Use sterile technique when changing dressing.
Clean site with chlorhexidine prep preferably.
Use biopatch every time you put a new dressing.
Flush central line ports with 5 cc NS at least once a shift.
Remove central line as soon as possible.
Change femoral and emergent lines hours after placement if possible to a new site.

8. Current Local Data

9. Implementation
Educate Intensive Care nurses on proper documentation on Central Line insertion, maintenance and removal via CERNER, clip form/flow sheet.
Educate ICU nurses on Evidence Base Guidelines recommendations for insertion, maintenance and removal in order to reduce CLABSI rates
In order to prevent CLABSI we will be monitoring compliance with guidelines.
Central Line rounds will take place every week.
Assistant personnel will be included at the time of central line maintenance.

10. Outcomes
Intensive Care nurses will be aware of proper documentation on Central Line insertion, maintenance and removal via CERNER, clip form/flow sheet.
ICU nurses will practice Evidence Base Guidelines recommendations for insertion, maintenance and removal in order to reduce CLABSI rates
Confidence interval will indicate about the same or less as the national experience for Med-Surg ICU
Confidence interval will indicate about the same or less as the national experience for UMC trauma ICU.
CLABSI numbers will be reduce 25% after proper education and implementation of Evidence Base Practice by the end of the fourth quarter of 2015

11. References
Central Line-associated Bloodstream Infection (CLABSI). (2012, May 17). Retrieved May 5, 2015, from http: // O’Grady,AlexanderM,DellingerEP,GerberdingJL. (2012, April) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. Preventing bloodstream infections from central line venous catheters. (n.d.). Retrieved May 5, 2015, from The Joint Commission. (n.d.). Retrieved May 5, 2015, from Thomb, K., Custer, M., & Rew, C. (2013, March 1). Successful Implementation of a Unit-Base quality Nurse to Reduce Central Line associated bloodstream Infection