16.00 16.30 tim spencer - publiceren
DESCRIPTION
TRANSCRIPT
Disclosures
• Teleflex Ultrasound-‐guided central venous & arterial access: compliance within prac=ce – Faculty Member
What we already know
• Currently, nurses provide majority of care to VADs
• > ~95% hospital admissions will have some form of VAD within 24hr of admission
• OSen first line of management during any given hospital admission -‐ ER
• Vascular access procedures are the most commonly performed invasive procedure in the world today.
What we already know
• With that knowledge, clinicians need to be aware of the types of CVCs available, the advantages and disadvantages of each type, and how catheter selec=on and implementa=on of recommended preven=ve strategies can impact the CRBSI rate.
• These devices and strategies work together as a collabora=ve approach but cannot individually provide the significant impact needed to affect CRBSIs.
Typical ICU trauma pa=ent;
~ mul=-‐infusion therapy
~ mul=ple wounds
Portals for cross-‐infec=on?
Early Assessment
• Selec=on of device(s) based on a needs assessment
• Minimises the need for inappropriate devices
• Ongoing monitoring is essen=al
• Products/device review and analysis • Defining terminology and repor=ng outcome measures
The powers of observa=on..
Shoe leather surveillance is the best form of monitoring
Interven=on
• Preven=on of infec=on • Maintaining a closed IV system
• Maintaining a patent device
• Preven=ng damage to the device (Malleb and Bailey 1996)
• Surveillance, management, and leadership following project implementa=ons
CRBSI or CLABSI? Confused yet?
CDC says what..
• CRBSI criteria require one of the following: – A posi=ve semi quan=ta=ve (>15 colony-‐forming units [CFU]/catheter segment) or quan=ta=ve (>103CFU/catheter segment) cultures whereby the same organism (species and an=biogram) is isolated from the catheter segment and peripheral blood
– Simultaneous quan=ta=ve blood cultures with a ≥5:1 ra=o CVC versus peripheral
– Differen=al period of CVC culture versus peripheral blood culture posi=vity of >2 hours
• A CLABSI as defined by CDC, is a primary (i.e, no apparent infec=on at another site) BSI in a pa=ent that had a central line within the 48-‐hour period before the development of the BSI. BSI is defined using either laboratory confirmed bloodstream infec=on (LCBI) or clinical sepsis (CSEP) defini=ons
• In the CDC/NHSN defini=on of CLABSI, there is no minimum period of /me that the central line must be in place in order for the BSI to be considered central line–associated.
• The culture of the catheter -p is not a criterion for CLABSI!
Involving people..
• While most facili=es have tradi=onally disseminated infec=on data to hospital-‐wide commibees and administra=on, it is essen=al to also share this informa=on with the people who can actually make a difference—the direct care providers. Involving proceduralists who place the central venous catheters provides valuable feedback on poten=al technique issues.
Maximal barrier..
Products
• Analysis of specific types of products, (e.g. catheters, valves, site dressings, fluid bags, accessory products), con=nues to have benefit.
• But the true value of a specific product is best recognized in rela=on to all products that make up the pa=ent’s IV system.
Educa=on and training
• Mul=ple studies have demonstrated improvement with educa=on and training
• Physicians have currently no creden=aled/standardized method for learning catheter inser=on
• Many nurses have very lible exposure to principles and prac=ces of catheter management
• See one, do one, teach one method is NOT an adequate educa=onal tool!
• Mul=disciplinary group to create educa=onal plan
Preven=ons matched with source of organisms
Skin • Hand hygiene
• Skin an=sepsis • Inser=on site • Maximal barriers
• Catheter stabiliza=on • Dressings • An=microbial catheters
Preven=ons matched with source of organisms
Infusate • Single use flushing system
• Laminar air flow work bench • Strict adherence to asep=c technique when
Preven=ons matched with source of organisms
Catheter hub manipula=on • Hand hygiene
• Number of catheter lumens • Hub an=sepsis • Tubing and cap changes
• Flushing procedures • An=microbial catheters • Needleless injec=on devices
Who’s who in the zoo!
• Reducing CRBSI is EVERYONES business, not just one clinician specialty
• Nurses, physicians, respiratory therapists, technicians, as well as pa=ents themselves, take the responsibility to prevent infec=ous complica=ons through constant vigilance in monitoring the device Its not your -tle, but it’s the difference you
make at the bedside that counts
• Webcast was to share knowledge and best prac=ces on IV therapy management including CLABSI preven=on and beyon
hbp://vioca.st/Andrew_Jackson_Infec=on_Preven=on_IV_Management_Educa=onal_Webcast