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mortycat2001
Our CLABSI rates are high, seem to be related to care and maintenance.

I work at a 600+ bed hospital. We are trying to develop a program aimed at care and maintenance as well as look at everything that we do related to central lines. Does anyone know of any successful programs or of hospitals of similar size with the same situation that have had success lowering their rates? We switched to Cook antimicrobial PICC's over a year ago in an effort to lower the rates but they have not helped and they seem to clot more easily. Our cathflo usage is way up. We are very frustrated!!

 

Thanks

Patty

lynncrni
You need to take a hard look

You need to take a hard look at all of the following:

1. what needleless connector you are using

2. how that NC is cleaned before each entry into the system. Consider using one of the protection caps for your NC

3. is the correct flushing and clamping technique being used for the specific NC in use

4. are continuous infusions being frequently disconnected to change gowns, go off the unit, ambulate, etc. If so, stop this practice immediately!

5. how are the sets used for piggybacking secondary meds. they should remain connected and use the backpriming method.

6. how do you manage and protect sets used only for intermittent infusion. Sterile end cap MUST be placed on the male luer end after each use and that set must be discarded after no more tha 24 hours

7. who is preparing syringes for catheter flushing - nurses, pharmacists or purchaing prefilled syringes? Prefilled is much cheaper and better quality if you choose a brand that is terminally sterile vs one that is aseptically filled. Completely sterile syringes are yet another category for use on a sterile field.

8. reduce hub manipulation by only drawing blood sample from CVAD when there is absolutely no other veins for drawing.

In other words focus on that catheter hub and everything that is being done to it. Reduce hub manipulation as much as possible. Look at both sides of this system - the hub and NC along with everything that is attached to it. Skin and insertion procedures produce the greatest risk for infection within the first week of dwell. After that the risk shifts to the catheter hub!

Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Turena Reeves
500+ bed hospital reduce our
Natalie F.
 Does your facility

 Does your facility investigate to determine if your infections are intra or extra luminal?  Might help target where the issues are.

Timothy Royer B...
A better Care and Maintenance Bundle to Achieve Zero CLABSI

This is what we did at the facility where I work.  Published Nov/Dec. 2010 JIN

Royer, T. Implementing a Better Bundle to Achieve and Sustain a Zero Central Line-Associated Bloodstream Infection Rate, J. Infusion Nursing, Nov/Dec. 2010; 35(6); 398-406.

 

Tim Royer BSN CRNI VA-BC

kathykokotis
is it the PICC first off

First off is it the PICC.  In other words your hospital does a root cause analysis and breaks down the PICC's versus other central lines and therefore it is the PICC?

Next are these insertion related (usually in the first week)

next are these extraluminal or intraluminal.  From dressing sites or intraluminal from poor cleaning/infusates contaminated/hook-ups contaminated?

Do you have a line team to do dressing changes?  do you have Biopatch?  Do you have standarized dressing change kits with sterile supplies?

Do you use multi-dose vials or single dose vials/prefilled syringes for flush?

what organism are you dealing with is very helpful to know?

What do you scrub the hub with and for how long

Are these CLA-BSI or CR-BSI?

A root cause analysis has to do be done in order to figure the problem to get to a solution

Kathy Kokotis

Bard Access Systems

mortycat2001
The majority are well beyond

The majority are well beyond a week. There are all types of central lines but 44% are PICC because we place more PICC's. There are multiple different organisms that have been cultured. They seem to be intraluminal. We are doing a root cause analysis but have not found anything that is a trend. We use alcohol and are supposed to scrub the hub for 15 seconds. We do not have a specific team to change dressings each nurse does their own and we do have standardized dressing change kits. We do use biopatches.We have been inservicing different units but our PICC service is only 4 nurses for a 600+ bed hospital. We use single dose pre filled saline syringes for flushes. We are considering changes to neutral pressure claves. We currently are using the positive pressure claves. Any suggestions would be appreciated.

 

 

lynncrni
Then definitely look to the

Then definitely look to the catheter hub and everything connected to it and all manipulations of it as the source of these infections. Look at IV set management, especially intermittent sets. Re needleless connectors, we know that right now the publications show a trend toward external blunt cannula/split septum devices as those with the lowest risk for infection. There is also an invitro study showing that scrubbing for even 15 seconds does not produce a connection surface that is free of organisms. You might want to also look at the protection caps that are placed on the NC between uses to prevent their contamination. Also what is your policy for using all CVCs for drawing blood samples. Remember all hub manipulation increases the risk of CRBSI. You can not only focus on one aspect or one product type, but you must look at everything that is done to and with all catheters. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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