CLABSI Surveillance Survey by liaoqinmei


									    CLABSI Surveillance

        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
      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

                                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.,
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,
          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.
               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
          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
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-
                                           Key Terms
                  Case 1
Patient admitted to the ICU for R/O CVA.
In ED patient is intubated and has CVC
                 ,             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
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
to be “red”.
Blood culture results
 – S epidermidis (2/2)
 – No growth
Vancomycin added – both antibiotics cont
X 10 days
Would you count this as CLABSI?
                    Case 4
Patient admitted to ICU w/ colon cancer. Bowel
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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