Here is what has been published- biofilm (the cause of CRBSI) is found in greater amounts on the extraluminal catheter walls within the first week after insertion. This indicates that the source of organisms would be the skin. This could be from improper skin antisepsis, poor dressing and stabilization practices, or lack of proper hand hygiene. After the first week, there is a greater amount of biofilm on the internal catheter walls, indicating that the bugs are coming from hub manipulation. This means tubing management, needleless connectors, appropriate cleaning practices, blood sampling, med administration, and hand hygiene. This approach has been the most effective to attempt to determine the origin of the bugs and thus the factors to focus on for prevention. Both extra and intraluminal sources require strict attention.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Our ID director will call it CRBI for sure if it occured within 48 hours of insertion, unless we have 2 sets of blood cultures taken during insertion that turned positive. (we always take 2 sets of blood culture if we insert a PICC in febrile patients).
She may consider CRBI related to insertion technique up to 5 days from time of insertion, depending on what is growing in the cultures, how many other CVC the patient has the diagnosis etc. Everything after that, they attribute it to catheter care.
ID and PICC team work very closely togather, we meet every 3 month to review all PICC patients with positive blood cultures. The CRBI report is done exclusively by our IC team, and we compare PICC and other CVC infection rates.