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Alma Kooistra
CRBSIs, PICCs vs. other Central Catheters

Along with everyone else, we are fighting the CRBSI battle.  We've renewed our efforts and have had (at best) mixed results.  Today I was questioned why PICCs tend to show up with greater numbers of CRBSIs than our subclavian/IJ lines do.  I mentioned catheter days vs numbers of line infections and was told that even with that calculated in we are seeing greater numbers of PICC blood system infections than with our other 'centrals'. 

I believe we're getting hit with care issues more than anything.  Catheter related infections are typically showing up multiple days post line insertion.  Many of the offending organisms are enteric.  On the other hand, if care is the problem, why are we not seeing the same problems with our peripheral IVs? 

We've done a big push for 10 second hub scrubs (just trying to get past the 'cursory swipe' they used to use).  We're monitoring compliance and it seems to be better.  Yet we continue to get hit with CRBSIs.  We're tracking unit occurances and doing education there.'s just so frustrating.

Still, none of this explains why the PICCs are seemingly more often a piece of this than other catheters are.  HELP!  I need a magic wand!

Alma Kooistra RN CRNI

anna liang
for the picc CRBSIs cases,

for the picc CRBSIs cases, what do they have in common?

diagnosis, indication for central access / treatment plan (meds, duration), why those patient get PICCs instead of other CVCs, any risk factors for infection, dwell time?

if you find what they have in common, keep a close eye on future similar cases.

for example, for patients receiving TPN for one week, do you see CRBSIs higher among PICC patients vs IJ/SC CVC patients?

for fair comparison, you might want to consider controlling some factors.

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Being I am an infection control RN I first have to ask how is the infection decided on.  Are they cultruring tips which is useless.  Are they doing surveillance and just guessing?  You need to get to the bottom of how this is assessed.  If the patient is spiking a temp this is not an infection just cause a line is pulled.  I had the same problem at a 700 bed hospital and after we pulled all the charts we find no labs.  It was all based on a surveillance definition.  I need more info to help you get to the bottom of this.  You may be reporting catheter infections that are not even catheter infections.



Kathy Kokotis

Bard Access Systems

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