Central Catheter Associated Infections: A Case Study

In 2013, a magnet recognized hospital, Baptist Health Lexington, reduced CAUTI rates in ICU patients by 60% (Roser, Piercy & Altpeter, 2014). The study included six interventions that were followed by the staff in the effort to reduce CAUTI. The six interventions included: “communication of CAUTI data to interdisciplinary teams, a nurse-driven, physician approved protocol, problem analysis using Lean principles, daily unit-based surveillance rounds, silver alloy urinary catheters, and an antimicrobial bundle comprised of two cleansing products for patients with an indwelling urinary catheter” (Roser, Piercy & Altpeter, 2014). The nurse-physician protocol allowed for nurses to assess whether the catheter was still necessary and if found not to be, the nurse could discontinue it. This resulted in a 58% decrease in the number of catheters used (Roser, Piercy & Altpeter, 2014). An education session was implemented by nurses using principles from the Lean system that checked the capability of nurses to understand just how dangerous CAUTI can be. It was found that no single intervention alone could reduce the occurrence of CAUTI development. Nurses must integrate several interventions to have an effective result at lowering the rates. However, this particular study found that after the use of the antimicrobial bundle, rates of CAUTI did decline. Roser et al. (2014) emphasized that education and awareness of

Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.

Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.

Central lines are a common device used world wide in acute care settings for eligible patient populations such as those receiving chemotherapy, patients with poor venous access, or for those that require prolonged treatment of intravenous medications. Although central lines provide many advantages, they place patients at high risk for acquiring central line associated blood stream infections (CLABSI). CLABSI's are a serious complication associated with central lines and in some cases can be life threatening. There are many evidence based approaches that are used in acute care settings to reduce the incidence of CLABSI's such as meticulous skin care, daily bathing with chlorehexadine surgical scrub, and strict sterile technique when changing central line dressings. These prevention measures are a standard of care nationwide for patients with central lines since they are cost effective and evidence based. Unfortunately, even with proper implementation and compliance with these interventions, CLABSI's are still prevalent amongst vulnerable patient populations.

Central venous catheters, usually called CVCs, are extremely important for patients in any type of intensive care unit. It is because of their crucial role in the care of these patients that their troublesome risk of catheter-related bloodstream infections, sometimes referred to as CR-BSIs, has developed into such a problem. There are approximately 80,000 CR-BSIs diagnosed each year in the United States alone. These infections lead to nearly 28,000 patient deaths in intensive care units. Not only is this a dreadful loss of life; it is also incredibly expensive. Extra care and treatment for a patient suffering from a CR-BSI can cost an average of $45,000. In fact, these infections can cost as much as $2.3 billion for the United States each

Lastly, non-adherence to Aseptic techniques for surgical patients and with the use invasive of devices such as urinary catheter and central lines can pose as a threat to patients. Bathing patients prior to surgery with a chlorhexidine solution rather than regular soap has proven to reduce the spread of hospital acquired infections. Following protocols with urinary catheters and central lines and also following the guidelines in the care and maintenance of such devices. Another factor is the importance of using chlorhexidine solution for patients who have central lines in an effort to prevent getting an infection in the blood stream. Finally, the importance educating patients on all lines and surgical site care. According to Lobley, “the National Institute for Health and Clinical Excellence found that surgical site infections (SSIs) accounted for 14% of all HAIs and affected 5% of all surgical patients” (Lobley, 2013). Surgical site infection which is another form of hospital acquired infection can

In the healthcare, evidence-based guidelines are utilized to prevent complications that can be very significant to both the patient and the healthcare in general. Having worked in different health care settings including, home-health, long-term care facilities, rehabilitation hospitals, long-term acute care, and acute care, I have come across various healthcare associated infections (HAIs). For my project, I will focus on prevention of central line-associated bloodstream infections (CLABSIs). I have seen the importance of central lines in management of patient care, be it in nutrition supplementation, hydration, or medication treatments in all the mentioned different settings. I have also encountered infected central lines and the risk they pose to the patients. According to the Centers for Disease Control and Prevention (CDC), CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable (CDC, 2010).

1) Summary of Article: Indwelling catheter use is common, but so are infections associated with them. About 80 percent of all urinary tract infections in hospitals are caused by catheters, and about 20 percent of all hospital infections total are UTIs. Evidence-based practice should be used for insertion, maintenance, and removal. Catheters should not be left in longer than they need to be. Unfortunately, this research shows poor administrative efforts are to blame for

Also another serious complication of CAUTI is BSI (Blood stream infections) that can be fatal if not caught and treated promptly. “The Clinical Performance of Quality Health Care, along with Joint Commission” offers standards and objectives for facilities to assess measure and improve their standards at the lowest cost possible. The database covers nursing care and education, along with guidelines on prevention. Moreover the JCAHO regulatory standards for catheterized patients are explained and the documentation that is expected when JCAHO inspections are rendered in a facility. The source “Stop orders to reduce inappropriate urinary catheterization in hospitalized patients” states that by following standard precautions with every patient these infections can be prevented. . Also the source explored whether catheters should be used at all in an effort to decrease the incidence of CAUTI’s. Intermittent catheterizations along with supra-pubic were explored with a decreased incidence of bacteria being present in the bladder afterwards. The source “Strategies to prevent catheter-associated urinary tract infections in acute care hospitals” offered ways of cleansing and disinfecting the skin before insertion to reduce the risk of infection. Many CAUTI’s are linked to bacteria harboring in or around the site at insertion. By using not only aseptic technique but also cleansing the skin with chlorhexadine can decrease he incidence of infection

As common with past iterations, the update makes it possible to develop clinical recommendation practices based on the theoretical rationale, applicability and the effectiveness of the intervention, and scientific data. The recommendations usually range from those being implemented at the time of carrying out a particular treatment procedure on a patient during insertion of the central venous catheter to those related to institutional practices geared towards reducing the CLABSI. Central line infection impacts organizations as well as patients’ cultural background. This health problem has posed a great challenge to individuals and organizations that are forced to spend lots of money in finding proper treatment to those infected. Since central line infection is increasingly becoming common, attention is focused on developing preventive measure to reduce the rate of deaths in patients who develop the infections. Moreover, with the realization that central line infection can be curtailed through evidence-based practices, the prevention of these infections is becoming an attainable goal for many health facilities, health care systems as well as payers. These efforts underscore the need to successfully implement the CLABSI prevention initiatives across the globe through engagement in enlightenment of staff about central line infection and

-A task force was created to address the increase number of central line associated bloodstream infections at Newark Beth Israel Medical Center from 1/12 to 12/12. However the study ended 12/13 as a control of the task forces implemented strategies. There were 68 adult patients which had a rate of about 14.7 per 1000 central line days in an adult inpatient patient. Most infections were in the ICU.

Quality improvement in health care has been and will continue to be a beneficial process in helping with many problems faced in healthcare. According to U.S Department of Health and Human Services (2011) “quality improvement consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups” (p.1). These systematic and continuous actions have indeed led to many health care improvements throughout the years including reductions in infection rates, medication errors, and health care costs. One major current concern in the health care field is the presence of catheter associated bloodstream infections (CABSI’s). Provonost, Marsteller, and Goeschel (2011)

One of the issues that has been addressed since the initial release of the report is the need to eliminate the occurrence of hospital-acquired infections (HIAs). As noted by Knudson (2014), current efforts to improve healthcare practices encompass new regulations and prevention efforts to eliminate, or at least reduce, HAS, including catheter-associated urinary tract infections (CAUTI). The following paper discusses current efforts in CAUTI prevention, contemporary regulations and mandates, and a quality improvement plan that can be initiated at the focus clinical site.

Central line-associated bloodstream infections, or CLASBIs, are a common issue throughout all types of health care facilities. Each year in intensive care units and other acute care facilities, the Centers for Disease Control and Prevention estimates that more than 30,000 CLASBIs occur. These infections are