Central Line Infections

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.

NRS-433V Week 5 - Evidence-Based Practice Presentation - Healthcare Associated Infections [12 Slides + Speaker Notes]

One of the ways to combat the incidence of Central Line Associated Bloodstream Infection (CLABSI) is by following the proper steps in Central Line Dressing changes. The topic you picked is an important one, both for patients and our overall health care system as well. If nurses will learn, and follow the proper manner in the way Central Venous Lines should be changed it can have a positive outcome for patients. CLABSI can be fatal to the patient, this can devastate the patient's family as well. “Although a 46% decrease in CLABSIs has occurred in hospitals across the U.S. from 2008-2013, an estimated 30,100 central line-associated bloodstream infections (CLABSI) still occur in intensive care units and wards of U.S. acute care facilities each

The ICUs are associated with over 15 million catheter days while there is indication that only 24.4% of CVC use occurs outside the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013). This implies that millions of patients in the ICUs are at a high likelihood of developing CLABSI

Influence Adherence to Central Line Bundle Practices and Central Line-Associated Bloodstream Infections in the VA?. American Journal Of Infection Control, 44S89-S90. doi:10.1016/j.ajic.2016.04.106

Bloodstream infections are a common outcome of patients with a central line and are known to be a cause of mortality in hospitals. There are a multitude of risk factors that can contribute to a central line-associated bloodstream infection (CLABSI). This can include, but are not limited to, intrinsic factors that are not controllable by healthcare team members, such as a patient’s age, underlying diseases or conditions, and patients’ gender. There are also extrinsic factors that are within the control of healthcare members, such as prolonged hospitalization before for central line insertion, nutrition, location of site, multilumen lines, deficiency of sterile barriers for central line insertion and effective cleaning of ports (The Joint Commission,

This paper will examine research on multidisciplinary methods used to prevent central line associated blood stream infections (CLABSIs). CLABSIs are a large contributor to increased healthcare costs and increased mortality rates. Research shows how the interventions included in a central line care bundle decrease the risk of CLABSIs. Evidence shows how important it is to target the micro-organisms that pose the biggest threat and how take action against those organisms. Through research a model based off of the Six Sigma Strategies have been shown to be an effective tool in decreasing the occurrence of CLABSIs and decreasing cost for hospitals. There will be discussion of appropriate nursing care that can be implemented into practice to help ward off these life threatening microbes.

For over a decade, healthcare associated infections (HAIs) have been at the forefront for improvement in hospitals across the nation, with central line associated blood stream infections (CLABSI) being a frontrunner of HAIs investigated as a major area for improvement. A central line can be either a central venous catheter (CVC) or a peripherally inserted central catheter (PICC) and has many uses in intensive care units, inpatient units, and home health care including administration of antibiotics, TPN, and chemotherapy treatment. Remarkable improvements over the past decade have been made in order to shrink the rate of CLABSIs with measures and ongoing research to continue to diminish the number of central line infections seen in hospitals.

The issue is the increase in the number central line infections on the general Medical-Surgical floor. The method used to determine the issue on the Medical-Surgical unit is personal and professional experience. The nursing staff on the Medical-Surgical unit has recently experienced an increase in patients with central lines. This is clinically significant, because an increase in central lines increases the risk for increased central line infections. Infections in the bloodstream are attributed to increased length of stay and increasing costs, including the reduction in reimbursement to the facilities (Medina et al., 2014). Reducing central line infections will reduce hospital costs, reduce stress for the patients, and allow the nursing staff to provide patient safe practice.

As a visionary researcher, the researcher viewed the discrepancy between the central-line-bundle guidelines and their actual implementation as a cause of the current numbers of central-line bloodstream infections (CLABSI). CLABSIs affect approximately thirty thousand and one hundred patients in intensive care units (ICUs) annually and cost thousands of dollars per episode (Health Research & Educational Trust, 2017). But most of the patients in ICUs need a central line which is a tube placed in a large vein to give medications or fluids. The researcher reviewed many qualitative and quantitative studies to examine the impact of adherence to central-line-bundles on the number of CLABSIs among adult patients in ICU. All studies presented central-line

In my present role of in-patient transplant coordinator, I round with the transplant surgical team daily. The interdisciplinary team is aggressively looking for opportunities to minimizing opportunistic infections for example: de-escalating antibiotics, removing bladder catheters, as well as removing central lines. If the patient is a hard stick, a peripherally inserted central catheter (PICC) is placed. A study by Rutkoff, (2014) mentioned that an integration of antimicrobial PICCs into the current infection prevention practices should be practiced for reduction central line associated blood stream infections.

The team reinforced teaching on proper changing of central line dressing and management, observed nurses techniques as well as implemented the weekly change of the needle-free system caps. The dressing change technique uses “proper hand-washing, donning of masks, proper cleansing with ChloraPrep (chlorhexidine gluconate and isopropyl alcohol skin preparation), correct dressing (Biopatch) placement, and application of occlusive dressing (IV3000).” (Cooney-Newton, 2015) This resulted in CLABSI rates reducing by 50% for two years following the

Although a literature review was not specifically provided in it’s own section, overall general concepts were mentioned and referenced as a reason for the study. The researchers did focus extensively on articles that covered central line associated infects, hospital infection control and implementation of catheter bundles. Of the 36 articles referenced, 26 of them were dated between 2010 and 2015, and the remaining 10 were dated between 2002 and 2009, therefore the time frames for these articles are appropriate for the study.

Doing once a week round at Long Term Acute Care facility with Dr Teena Chopra, Pharmacy Director, RN, Chief clinical officer; to intervene and reduce catheter- associated Urinary Tract Infections (CAUTIs), Central Line-Associated Bloodstream infection (CLABSI).