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CLABSI Surveillance Survey Mary Andrus, BA, RN, CIC Northrop Grumman Contractor Centers for Disease Control and Prevention , Atlanta, GA August 15, 2008 LCBI – Criterion #1 Example: Jon Smith had a PICC line inserted on admission (June 1). On 4, hospital day 4 he became confused and experienced chills. Blood cultures were drawn which grew E. faecalis. Mr. Smith meets the criteria for LCBI Criterion #1. One or more blood cultures means that at least one bottle from a blood draw is reported by the laboratory as having grown organisms (i.e., is a positive blood culture). culture) Recognized pathogen does not include organisms considered common skin contaminants. A few of the recognized pathogens are Staph aureus, Enterococcus spp., E. coli, Pseudomonas spp., Klebsiella spp., Candida spp., etc. Criterion LCBI – C it i #2 The phrase “two or more blood cultures drawn on separate occasions means: 1. That blood from at least two blood draws were collected within two days of each other, and 2. That at least one bottle from each blood draw is reported by the laboratory as having grown the same common skin contaminant organism (i.e., is a positive blood culture) Note: If special pediatric blood culture bottles are used, only one draw. Therefore bottle may be inoculated per blood draw Therefore, to meet this part of the criterion, two would have to be culture-positive. Criterion LCBI – C it i #3 Note also – although Criterion #3 can only be used for infants and neonates, Criteria 1 and #2 can also be used in this l i population. Definition CLABSI D fi iti A central line-associated bloodstream infection (CLABSI) is a primary bloodstream infection (BSI) in a patient that had a central line in place at the 48-hour time of or within the 48 hour period before the development of the BSI. Note: there is no minimum period of time that the central line must be in place before a BSI is considered central line- associated. Key Terms http://www.cdc.gov/ncidod/dhqp/nhsn_members.html Questions Case 1 Patient admitted to the ICU for R/O CVA. In ED patient is intubated and has CVC placed. , p g Within 48 hours, CXR shows progressive consolidation in LL lobe, and patient is placed on therapy for pneumonia. Day 10, patient is febrile and 2 sets of blood cultures are positive for S. maltophilia. Day 16, an ETA culture grows S. maltophilia Would t thi W ld you count this as CLABSI? Case 2 Patient transferred from LTAC for AMS, and has CVC placed in ICU. Admission blood cultures negative Patient is comfort care only per patient/family wishes Day 10 – patient febrile and 2 sets blood cultures and central line cath tip are all positive for A. baumanii. Day 11 – life support withdrawn and patient dies Would you count this as CLABSI? Case 3 Patient transferred from LTAC with pneumonia and placed on Zosyn. Central line l d in ICU. placed i ICU Day 5 – patient febrile, central line site noted red to be “red”. Blood culture results S. – S epidermidis (2/2) – No growth cont. Vancomycin added – both antibiotics cont X 10 days Would you count this as CLABSI? Case 4 Patient admitted to ICU w/ colon cancer. Bowel resection. Central line placed in OR 2 wks – Blood cultures: – Candida (1/2) from peripheral stick – Candida (2/2) from central line CT scan shows enterocutaneous fisula and abdominal aspirate culture g p grows E. faecalis. Would you count this as CLABSI? Case 5 Patient admitted to NeuroICU for recurrent brain tumor. Ri ht IJ central li placed. b i t Right t l line l d Two weeks later, patient is febrile, central li i ti it t d to be “red” d line insertion site noted t b “ d” and 1 set of peripheral blood cultures are positive E. cloacae. for E cloacae Central line is removed and culture of catheter tip is negative Would you count this as CLABSI?
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