on the cusp: stop bsi evidence for best practices for placement and maintenance of central lines
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On the CUSP: STOP BSI Evidence for Best Practices for Placement and Maintenance of Central Lines. Learning Objectives. Review evidence for the 5 key best practices for CLABSI prevention Remove unnecessary lines Hand hygiene Use of maximal barrier precautions - PowerPoint PPT PresentationTRANSCRIPT
© 2009
On the CUSP: STOP BSI On the CUSP: STOP BSI Evidence for Best Practices for Placement Evidence for Best Practices for Placement
and Maintenance of Central Linesand Maintenance of Central Lines
© 2009
Learning ObjectivesLearning Objectives
• Review evidence for the 5 key best practices for CLABSI prevention
– Remove unnecessary lines– Hand hygiene– Use of maximal barrier precautions– Chlorhexidine for skin antisepsis– Avoid femoral lines
• Review approaches for central line site care
MMWR. 2002;51:RR-10
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Hand Hygiene: The EvidenceHand Hygiene: The Evidence
Clin Infect Dis 1999;29:1287-94
Lancet 2000;356:1307-1312
Since 1977, 7 prospective studies have shown that improvement in hand hygiene significantly decreases a variety of infectious complications
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What are Maximal Barrier What are Maximal Barrier Precautions?Precautions?
• For Provider:– Hand hygiene– Non-sterile cap and mask
• All hair should be under cap• Mask should cover nose and mouth tightly
– Sterile gown and gloves
• For the Patient– Cover patient’s head and body with a large sterile drape
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Maximal Barrier PrecautionsMaximal Barrier Precautions
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Maximal Barrier Precautions: Maximal Barrier Precautions: The Evidence The Evidence
Author & Year
Study Design Type of
Catheter
OR for Infection
without MBP
Mermel1991
ProspectiveNon-randomized
Swan-Ganz 2.2 (p=0.03)
Raad 1994
Prospective Randomized
Central 3.3 (p=0.03)
Lee2008
ProspectiveNon-randomized
Central 5.2 (p=0.02)
Am J Med 1991;91(3B):197S-205S Infect Control Hosp Epidemiol 1994;15:231-8Infect Control Hosp Epidemiol 2008; 29:947-950
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Skin Prep: ChlorhexidineSkin Prep: Chlorhexidine
Ann Intern Med. 2002;136:792-801
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What Site is Best?What Site is Best?
• RCT of femoral (N = 145) and subclavian (N = 144) lines in the ICU
• Outcomes– Higher rate of infectious complications in femoral
group: 19.8% vs. 4.5% (p < .001) – Higher rate of thrombotic complications in femoral
group: 21.5% vs. 1.9% (p < .001); complete thrombosis 6% vs 0%
– Similar rates of mechanical complications: 17.3% vs 18.8% (p = NS)
JAMA 2001;286:700-7
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Strategies for Prevention: Strategies for Prevention: 5 Key “Best Practices”5 Key “Best Practices”
• Remove unnecessary lines
• Hand hygiene
• Use of maximal barrier precautions
• Chlorhexidine for skin antisepsis
• Avoid femoral lines
MMWR. 2002;51:RR-10
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Catheter Site and Hub CareCatheter Site and Hub Care
• Clean catheter hubs & injection ports with 70% alcohol or chlorhexidine/alcohol before accessing
• Change transparent dressings and perform site care with chlorhexidine– Routinely every 5-7 days– If the dressing is loose, soiled or damp
• Replace administration sets not used for blood products or lipids at least every 96 hours
Infect Control Hosp Epidemiol 2008;29:S22-30
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Action ItemsAction Items
• Assess compliance with best practices for catheter insertion
• Assess compliance with best practices for catheter site care
• Address solutions for barriers to best practice
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ReferencesReferences
• Guidelines for the Prevention of Intravascular Catheter-Related Infections; August 2002.
– www.journals.uchicago.edu/doi/abs/10.1086/344188
• Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals; October 2008.
– www.journals.uchicago.edu/doi/pdf/10.1086/591059