Implementation of central line-associated bloodstream infection prevention bundles in a surgical intensive care unit using peer tutoring

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

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Risk Factors and Clinical Impact of Central Line Infections in the Surgical Intensive Care Unit

Archives of Surgery ◽

10.1001/archsurg.133.11.1241 ◽

1998 ◽

Vol 133 (11) ◽

pp. 1241 ◽

Cited By ~ 42

Author(s):

Charalambos Charalambous

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Central Line ◽

Clinical Impact ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care

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Probabilistic Measurement of Central Line–Associated Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.255 ◽

2015 ◽

Vol 37 (2) ◽

pp. 149-155 ◽

Cited By ~ 3

Author(s):

Bala Hota ◽

Paul Malpiedi ◽

Scott K. Fridkin ◽

John Martin ◽

William Trick

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Probabilistic Method ◽

Bloodstream Infections ◽

Central Line ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Equal Distribution ◽

Final Model ◽

C Statistic

OBJECTIVETo develop a probabilistic method for measuring central line–associated bloodstream infection (CLABSI) rates that reduces the variability associated with traditional, manual methods of applying CLABSI surveillance definitions.DESIGNMulticenter retrospective cohort study of bacteremia episodes among patients hospitalized in adult patient-care units; the study evaluated presence of CLABSI.SETTINGHospitals that used SafetySurveillor software system (Premier) and who also reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).PATIENTSPatients were identified from a stratified sample from all eligible blood culture isolates from all eligible hospital units to generate a final set with an equal distribution (ie, 20%) from each unit type. Units were divided a priori into 5 major groups: medical intensive care unit, surgical intensive care unit, medical-surgical intensive care unit, hematology unit, or general medical wards.INTERVENTIONSEpisodes were reviewed by 2 experts, and a selection of discordant reviews were re-reviewed. Data were joined with NHSN data for hospitals for in-plan months. A predictive model was created; model performance was assessed using the c statistic in a validation set and comparison with NHSN reported rates for in-plan months.RESULTSA final model was created with predictors of CLABSI. The c statistic for the final model was 0.75 (0.68–0.80). Rates from regression modeling correlated better with expert review than NHSN-reported rates.CONCLUSIONSThe use of a regression model based on the clinical characteristics of the bacteremia outperformed traditional infection preventionist surveillance compared with an expert-derived reference standard.Infect. Control Hosp. Epidemiol. 2016;37(2):149–155

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The quest for the irreducible minimum: 8 years of performance improvement in preventing central line–associated infections in a surgical intensive care unit

American Journal of Infection Control ◽

10.1016/j.ajic.2005.04.067 ◽

2005 ◽

Vol 33 (5) ◽

pp. e60-e61 ◽

Cited By ~ 1

Author(s):

L.L. Fauerbach ◽

M.A. Gross ◽

C. Ruse ◽

R. Kelly

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Performance Improvement ◽

Central Line ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care

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Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)

British Journal of Nursing ◽

10.12968/bjon.2021.30.8.s37 ◽

2021 ◽

Vol 30 (8) ◽

pp. S37-S42

Author(s):

France Paquet ◽

Janette Morlese ◽

Charles Frenette

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

Blood Stream ◽

Central Line ◽

Surgical Intensive Care Unit ◽

Central Venous ◽

Surgical Intensive Care ◽

Venous Access Devices

This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings. Results: In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

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