Central line associated blood stream infection (CLABSI)

Document Sample
Central line associated blood stream infection (CLABSI) Powered By Docstoc
					             Central line associated blood stream infection (CLABSI)
                                  Project Charter
                 Scottish Patient Safety Programme Fellowship


Biologically, neonates are at particular risk of nosocomial infections because they
have naïve immune system, immature gut and deficient barrier function. In addition,
environmental factors such as restricted access, high ambient humidity, exposure to
multiple procedures add to the risk.

Late onset sepsis (onset >72 hours of life) is a common problem among infants
admitted to neonatal unit. Majority of these are secondary to central line infection.
The use and duration of a central line have been described as independent risk factors
for late on set sepsis. The reported central line associated blood stream infection
(CLABSI) rates range from 2.6 to 15.1 per 1000 central line days.

The rates in neonatal unit at Royal Hospital for Sick Children (RHSC), Glasgow are
likely to be high because of differences in patient characteristics compared to those
described in the literature. The patient population comprises of a mix of preterm and
term infants requiring treatment for surgical conditions, cardiac lesions, airway
problems and complex medical issues that preclude establishing early enteral feeding.
Consequently, central lines in the form of umbilical venous catheter (UVC),
percutaneously inserted central catheter (PICC) and surgically inserted central
catheter (SICC) are placed to facilitate long term parenteral nutrition. Some of these
infants are very sick and need invasive blood pressure monitoring that requires
umbilical arterial catheter (UAC) placement. All these infants are born in other
hospitals and transferred for further management, consequently, some of these infants
may already have central line in-situ prior to transfer and a proportion of them may
already have been infected.

Definition and diagnosis:

Central line: A venous or arterial line with tip in a major vessel and nearer to the
       Umbilical venous catheter (UVC)
       Umbilical arterial catheter (UAC)
       Peripherally inserted central catheter (PICC)
       Surgically inserted central catheter (SICC)

Central line infection: An episode of infection meeting following criteria:

1) At least one central line (UAC, UVC, PICC, SICC) in-situ
2) Absence of another clinically appreciated infectious focus
3) Presence of one or more positive blood cultures with following criteria being met:
         i) In SICC/UAC, positive blood cultures from both central line and peripheral
         venous sample or one positive culture and presence of one or more clinical
         and/or laboratory markers of generalised infection (e.g., rise in temperature or
         hypothermia, recurrent apnea/ desaturations / bradycardia, rise in CRP etc).

         ii) In PICC/UVC, one positive blood culture and presence of one or more
         clinical and/or laboratory markers of generalised infection.

         The recommended culture volume is ≥ 1ml.


To reduce newly (with onset of infection > 48 hours of admission) diagnosed
CLABSIs to < 2/1000 central line days among newborn infants admitted to the
neonatal unit at RHSC, Glasgow over a period of 9 months using Model for


        Reduce newly diagnosed CLABSI to < 2 per 1000 central line days
        Increase the time interval between two consecutive CLABSIs

Process measures:

        Compliance with hand washing
        Compliance with CLABSI prevention bundle
        Daily review of need for central line

Balancing measures:

        Increase in number of re-insertion of central lines

Outcome measures:

        Rate of CLABSI developed 48 hours after admission to the neonatal unit.

Guidance and changes:

        Establish central line infection prevention team

        Development of CLABSI prevention bundle

               Line Kit / Cart with check list

               Hand hygiene

               Insertion check list, standardised insertion technique and
          Maximum barrier precaution
             o The operator inserting central line should adhere to strict
                aseptic technique and wear sterile gown, gloves, hat and mask

          Disinfection with appropriate antiseptic
              o 0.5% Chlorhexidine and 70% Alcohol for skin antisepsis
              o 2% Chlorhexidine and 70% Alcohol (Chlorprep) for access

          Standardising the equipment.
              o Standardised dressing and infusion set (tubing, injection port
                  and catheter entry) for UAC / UVC / PICC / SICC

          Catheter care
              o Monitoring of central line for integrity and cleanliness
              o Replace continuous administration sets
                       every week: Wednesday and Sunday
                       immediately after blood products
              o Replace caps and smart sites
                       every 7 days
                       immediately after blood products

          Daily review of need for central line

   Educating and training staff on indications for central line, procedure for
    insertion & maintenance and infection control measures

       o Training of doctors on aseptic insertion of UAC, UVC, PICC
       o Training of nursing staff on aseptic procedure in preparing and
         connecting IV infusions
       o Supervision by trained personnel

   Surveillance
       o Investigation and analysis of each central line infection to learn from
           any failures
       o Data collection
       o Data display

   Regular feed back to the staff
       o Monthly reports

Shared By: