Catheter related infections in ICU

Catheter Related Infections

Mansoor Masjedi MD , FCCMShiraz University of Medical sciences

3rd international congress of critical care medicineTeh., Iran ; 20-22th Jan. 2016

AgendaAgendaWhat are the Devices.Epidemiology.Pathogenesis.Diagnosis.Treatment.Prevention.

Downloaded from: Infectious Diseases (on 16 November 2007 12:04 PM)

© 2007 Elsevier

8

Three ways stop cock (open connector) Single use vials, used

multiple times

Peripheral catheter with no sterile catheter dressing

Central line with no sterile dressing

Multiple use vials with inserted needles

CL insertion without maximal barriers

Per

cen

tag

e o

f H

AIs

Per

cen

tag

e o

f H

AIs

Country Type of Study/Unit HAI Rate (%) Year

Albania Adult ICUs 31.6 2008

Albania Surgical ICUs 22.0 2008

Argentina (INICC Study) Multicenter adult ICU 27.0 2003

Bangladesh Adult ICUs 30 2011

Brazil Multicenter newborn ICU 28.1 2004

Brazil Newborn ICU 50.7 2002

Brazil(INICC Study) Multicenter adult ICU 29.6 2006

Bulgaria Newborn ICU 1.9 2011

Chile Hospitalwide 14.0 2001

China Hospitalwide 3.04 2005

China Newborn ICU 11.6 2007

Colombia Newborn ICU 5.3 2005

Colombia (INICC Study) Multicenter adult ICU 12.2 2006

Costa Rica (INICC Study) Adult ICU 4.8 2009

Croatia (INICC Study) Adult ICU 7.0 2006

Cuba (INICC Study) Multicenter adult ICU 22.4 2011

Egypt Pediatrie ICU 23.0 2005

Egypt (INICC study) Adult ICU 32.8 2012

Egypt (INICC study) Pediatric ICU 24.5 2012

India Pediatric ICU 19.3 2011

India (INICC Study) Multicenter adult ICU 12.3 2005

Kosovo Adult ICU 64.3 2008

Kosovo Adult and New Born 17.4 2006

Kuwait Adult MS ICU 10.6 2008

Lebanon (INICC study) Adult ICU 9.8 2012

Macedonia (INICC study) Adult ICU 2.1 2010

Per

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AIs

Per

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AIs

Country Type of Study/Unit HAI Rate (%) Year

Mexico Hospitalwide 21.0 2002Mexico Multicenter adult ICU 23.2 2000Mexico (INICC Study) Multicenter adult ICU 24.4 2006Morocco (INICC Study) Adult medical ICU 19.3 2005Pakistan Adult ICUs 39.7 2007Peru (INICC Study) Multicenter adult ICU 11.2 2005Philippines (INICC Study) Adult ICU 19.1 2006Poland (INICC study) Adult ICU 24.3 2012Saudi Arabia Multicenter hospitalwide 2.8 2004Saudi Arabia Hospitalwide maternity 4.0 2002Saudi Arabia Hospitalwide 8.5 2002Saudi Arabia Adult ICU 19.8 2002Saudi Arabia Newborn ICU 35.8 2002Serbia Adult ICUs 40.8 2006Tanzania Multicenter hospitalwide 14.8 2003Tanzania Adult medical ICU 40.0 2003Tunisia (INICC study) Newborn and Pediatric 4.1 2010Turkey Adult ICU 12.5 2000Turkey Adult ICU 33.0 2003Turkey Adult ICU 51.8 2003Turkey Multicenter adult ICU 48.7 2004Turkey Neurology ICU 88.9 2005Turkey General pediatric wards 3.02 2012Turkey Intensive care unit 25.6 2011Turkey Intensive care unit 20.1 2011Turkey Newborn ICU 29.7 2010Turkey Adult ICU 16.6 2005Turkey (INICC Study) Multicenter adult ICU 20.5 2005

INICC 8 countries Multicenter adult ICU 14.7 2005

Range: 2% to 88%

Country Setting HAI per 1000 bed days

Year

Argentina (INICC Study) Multicenter adult ICU 90.0 2003Brazil Multicenter adult ICU 30.6 2006Brazil Multicenter newborn ICU 24.9 2004Brazil Newborn ICU 62.0 2002China Newborn ICU 14.9 2007Colombia (INICC Study) Newborn ICU 6.2 2005Colombia (INICC Study) Multicenter adult ICU 18.2 2006Costa Rica (INICC Study) Adult ICU 13.9 2009Croatia (INICC Study) Adult ICU 25.6 2006Cuba (INICC Study) Multicenter adult ICU 30.6 2011Egypt Pediatric ICU 40.0 2005Egypt Pediatric ICU 8.6 2011Egypt Multicenter ICUs 20.5 2012Egypt (INICC Study) Adult ICU 52.9 2012Egypt (INICC Study) Pediatric ICU 22.8 2012India Hospitalwide 36.2 2004India Pediatric ICU 21 2011India (INICC Study) Multicenter adult ICU 21.4 2005INICC (INICC Study) Multicenter adult ICU 22.5 2005Kuwait Adult MS ICU 20.6 2008Lebanon (INICC study) Adult ICU 11.85 2012Lithuania 5 Pediatric ICUs 24.5 2009Macedonia (INICC study) Adult ICU 4.5 2010Mexico (INICC Study) Multicenter adult ICU 39.0 2006Morocco (INICC Study) Adult medical ICU 20.4 2005Peru (INICC Study) Multicenter adult ICU 25.3 2005Philippines (INICC Study) Adult ICU 27.5 2006Poland (INICC Study) Adult ICU 21.9 2012Serbia Adult ICUs 65.6 2006Tunisia (INICC Study) Pediatric and Newborn 6.88 2010Turkey Burn ICU 18.2 2009Turkey General Pediatric wards 3.17 2012Turkey ICU 21.6 2011Turkey Newborn ICU 17.3 2010Turkey Adult ICU 30.2 2012Turkey (INICC Study) Multicenter adult ICU 48.4 2005Turkey (INICC Study) Neurology ICU 84.2 2005

HA

Is p

er 1

000

Bed

Day

sH

AIs

per

100

0 B

ed D

ays Range: 11 to 90 HAIs per 1000 Bed days

CL

AB

SI p

er

10

00

CL

da

ysC

LA

BS

I pe

r 1

00

0 C

L d

ays

Country ICU Type CLABSI per 1000 CL days

Year

Argentina Adult 11.4 2002

Argentina (INICC Study) Adult 30.3 2004


Brazil NICU 17.3 2010

Brazil PICU 10.2 2003

Brazil (INICC Study) Adult 9.1 2008

Brazil (INICC Study) Adult, PICU 34.0 2003

Brazil (INICC Study) NICU 3.1 2007

China NICU 18 2007

China (INICC Study) Adult 3.1 2011


Colombia (INICC Study) Adult 11.3 2006

Costa Rica (INICC Study) Adult 4.65 2009

Croatia (INICC Study) Adult 8.3 2006

Cuba (INICC Study) Adult 2.0 2011

Egypt (INICC Study) Adult 22.5 2011

Egypt (INICC Study) PICU 18.8 2011

El Salvador (INICC Study) PICU 10.1 2011

El Salvador (INICC Study) NICU 16.1 2011

India Adult, PICU, NICU 0.48 2010

India NICU 27.0 2011

India (INICC Study) Adult 7.9 2007

Iran Adult 147.3 2004

Country ICU Type CLABSI per 1000 CL days

Year

Kuwait Adult 5.5 2008Lebanon (INICC Study) Adult 5.2 2011Lithuania PICU 7.7 2009Macedonia (INICC Study) Adult 1.47 2010Mexico (INICC Study) Adult 23.1 2006Morocco (INICC Study) Adult 15.7 2009Peru PICU 18.1 2010Peru (INICC Study) Adult 7.7 2008Philippines (INICC Study) Adult 4.6 2011Philippines (INICC Study) PICU 8.23 2011Philippines (INICC Study) NICU 20.8 2011Poland (INICC Study) Adult 4.01 2011Saudi Arabia NICU 8.2 2009Tunisia Adult 15.3 2006Tunisia Adult 14.8 2007Tunisia (INICC Study) PICU, NICU 8.65 2010Turkey Adult 11.8 2010Turkey Adult 2.8 2011Turkey NICU 3.8 2012Turkey (INICC Study) Adult 17.6 2007INICC 15 countries NICU 13.7 2011INICC 18 countries Adult, PICU, 9.2 2008INICC 18 countries NICU 14.8 2008INICC 25 countries Adult, PICU, 7.6 2010INICC 25 countries NICU 13.9 2010INICC 36 countries Adult, PICU, 6.8 2011INICC 36 countries NICU 12.2 2011INICC 8 countries Adult, PICU, NICU 18.5 2006

CL

AB

SI p

er

10

00

CL

da

ys

CL

AB

SI p

er

10

00

CL

da

ys

Range: 2 to 147 CLABs per 1000 CL days

VA

P p

er 1

000

MV

day

sV

AP

per

100

0 M

V d

ays

Country ICU Type VAP per 1000 MV days

Year

Albania Adult, PICU, NICU 40.0 2008

Argentina (INICC Study) Adult 46.3 2004Brazil NICU 3.2 2010



Brazil (INICC Study) Adult, PICU 26.0 2003

Brazil (INICC Study) NICU 4.3 2007

China NICU 63.3 2007




Costa Rica (INICC Study) Adult 29.9 2009




Egypt (INICC Study) PICU 31.8 2011


El Salvador (INICC Study) NICU 9.9 2011India Adult, PICU, NICU 21.9 2010


Iran Adult 275 2004

Country ICU Type VAP per 1000 MV days Year

Kuwait Adult 9.1 2008

Lebanon (INICC Study) Adult 8.1 2011

Lithuania PICU 28.8 2009

Macedonia (INICC Study) Adult 6.58 2010

Mexico (INICC Study) Adult 21.8 2006

Morocco (INICC Study) Adult 43.2 2009Peru PICU 7.9 2010

Peru (INICC Study) Adult 31.3 2008

Philippines (INICC Study) Adult 16.7 2011

Philippines (INICC Study) PICU 12.8 2011

Philippines (INICC Study) NICU 0.44 2011

Poland (INICC Study) Adult 18.2 2011

Tunisia Adult 4.4 2006

Tunisia (INICC Study) PICU, NICU 5.56 2010Turkey Adult 27.1 2010

Turkey Adult 21.2 2011

Turkey NICU 13.76 2012

Turkey (INICC Study) Adult 26.5 2007

INICC 15 countries NICU 9.7 2011

INICC 18 countries Adult, PICU, 19.5 2008






INICC 8 countries Adult, PICU, NICU 24.1 2006

VA

P p

er 1

000

MV

day

sV

AP

per

100

0 M

V d

ays

Range: 3 to 275 VAP per 1000 MV days

CA

UT

I per

100

0 U

C d

ays

CA

UT

I per

100

0 U

C d

ays

Country ICU Type CAUTI per 1000 UC days

Year

Albania Adult, PICU, NICU 41.0 2008











India Adult, PICU, NICU 0.6 2010


Iran Adult 137.5 2004

Country ICU Type CAUTI per 1000 UC days

Year

Kuwait Adult 2.3 2008

Lebanon (INICC Study) Adult 4.1 2011

Lithuania PICU 3.4 2009

Macedonia (INICC Study) Adult 0.45 2010

Mexico (INICC Study) Adult 13.4 2006

Morocco (INICC Study) Adult 11.7 2009Peru PICU 5.1 2010

Peru (INICC Study) Adult 5.1 2008

Philippines (INICC Study) Adult 4.2 2011

Philippines (INICC Study) PICU 0.0 2011

Poland (INICC Study) Adult 4.8 2011

Tunisia (INICC Study) PICU, NICU 0.0 2010Turkey Adult 9.6 2010



Turkey (INICC Study) Adult 8.3 2007




INICC 8 countries Adult, PICU, NICU 8.9 2006

CA

UT

I per

100

0 U

C d

ays

CA

UT

I per

100

0 U

C d

ays

Range: 0.1 to 137 CAUTI per 1000 UC days

CLAB Rates Stratified Socio-Economic LevelCLAB Rates Stratified Socio-Economic Level

95%CI 18.06-20.1 6.5-7.5 7.3-7.8

Rosenthal VD, et al. Pediatric Critical Care 2012. Infection 2012.

CLAB Rates Stratified By Hospital TypeCLAB Rates Stratified By Hospital Type

95%CI 9.6-10.3 8.6-9.9 5.4-6.3


VAP Rates Stratified By Hospital TypeVAP Rates Stratified By Hospital Type

95%CI 13.3-14.2 19.8-21.0 6.4-7.7


21

PHILIPPINESPHILIPPINES

MACEDONIAMACEDONIA

PAKISTANPAKISTAN

EGYPTEGYPT

CUBACUBAEl SALVADOREl SALVADOR

KOSOVOKOSOVO

NIGERIANIGERIA

DOMINICANDOMINICAN

GUATEMALAGUATEMALA

LEBANONLEBANON

CHINACHINA

THAILANDTHAILAND

JAPANJAPAN

URUGUAYURUGUAY

MALAYSIAMALAYSIA

PANAMAPANAMA

1000 Hospitals of 200 CITIES of 54 COUNTRIES of 4 CONTINENTS

COSTA RICACOSTA RICA

CHILECHILE

SAUDI SAUDI ARABIAARABIA

UKRAINEUKRAINE

VENEZUELAVENEZUELA

CROATIACROATIA

VIETNAMVIETNAM

POLANDPOLAND

SUDANSUDAN

Papers published by INICC by Papers published by INICC by specific Country of Europe, Asia specific Country of Europe, Asia

and Africaand Africa

Five INICC International Reports Five INICC International Reports (One every second year, from 2006 to 2014)(One every second year, from 2006 to 2014)

Publication year 2006

Number of Countries

8

Peer Review Journal

Annals of Internal

Medicine

23

2008

18

American Journal of Infection Control

2010

25


2012

36


2014

43


Submitted

INICC2002-2005

(Annals 2006)

INICC2002-2007

(AJIC 2008)

INICC2003-2008

(AJIC 2010)

INICC2004-2009

(AJIC 2012)

INICC2007-2012

(AJIC 2014)

Number of Countries

8 18 25 36 43 Participating

CountriesArgentina, Brazil,

Colombia, India, Mexico, Morocco, Peru, and Turkey

Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba,

India, Kosovo, Lebanon, Macedonia,

Mexico, Morocco, Nigeria, Peru, Philippines, El

Salvador, Turkey, Uruguay

Argentina, Brazil, China, Colombia, Costa Rica, Cuba,

Greece, India, Jordan, Kosovo, Lebanon,

Lithuania, Macedonia, Mexico, Morocco, Pakistan,

Panama, Peru, Philippines, El

Salvador, Thailand, Tunisia, Turkey,

Venezuela, Uruguay

Argentina, Brazil, Bulgaria, China, Colombia, Costa

Rica, Cuba, Dominican Republic,

Ecuador, Egypt, Greece, India, Jordan,

Kosovo, Lebanon, Lithuania,

Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Puerto Rico, El Salvador, Saudi

Arabia, Singapore, Sri Lanka, Sudan,

Thailand, Tunisia, Turkey, Venezuela, Vietnam, Uruguay

Argentina, Bolivia, Brazil, Bulgaria, China, Colombia, Costa

Rica, Cuba, Dominican Republic,

Ecuador, Egypt, Greece, India, Iran,

Jordan, Kosovo, Lebanon, Lithuania,

Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines,

Poland, Puerto Rico, Romania, El

Salvador, Saudi Arabia, Serbia,

Singapore, Slovakia, Sri Lanka,

Sudan, Thailand, Tunisia, Turkey,

United Arab Emirates, Uruguay, Venezuela, Vietnam

Number of ICUs

55 98 173 422 503

INICC2002-2005

(Annals 2006)

INICC2002-2007(AJIC 2008)

INICC2003-2008(AJIC 2010)

INICC2004-2009(AJIC 2012)

INICC2007-2012(AJIC 2014)

Medical Cardiac ICU

CLABSI - 9.9 (8.7 – 11.3) 8.5 (7.5 – 9.7) 6.2 (5.6 – 6.9) 3.5 (3.1 – 3.9)CAUTI - 6.4 (5.3 – 7.7) 4.4 (3.5 – 5.3) 3.7 (3.2 – 4.3) 5.9 (5.4 – 6.4)VAP - 20.2

(17.0 – 23.9)14.9

(12.4 – 17.9)10.8

(9.5 – 12.3)11.5

(10.5 – 12.5) Medical-surgical ICU

CLABSI - 8.9 (8.4 – 9.4) 7.4 (7.2 – 7.7) 6.8 (6.6 – 7.1) 4.9 (4.8 – 5.1)CAUTI - 6.6 (6.2 – 7.0) 6.1 (5.9 – 6.4) 7.1 (6.9 – 7.4) 5.3 (5.2 – 5.8)VAP - 19.8

(14.2 – 27.1)14.7

(14.2 – 15.2)18.4

(17.9 – 18.8)16.5

(16.1 – 16.8) Pediatric ICU CLABSI - 6.9 (5.6 – 8.3) 7.8 (7.1 – 8.5) 4.6 (3.7 – 5.6) 6.1 (5.7 – 6.5)CAUTI - 4.0 (2.4 – 6.2) 4.4 (3.6 – 5.4) 4.7 (4.1 – 5.5) 5.6 (5.1 – 6.1)VAP - 7.9 (6.0 – 10.1) 5.5 (4.9 – 6.0) 6.5 (5.9 – 7.1) 7.9 (7.4 – 8.4) Newborn ICU (1501-

2500 g)

CLABSI - 15.2 (10.3 – 21.5)

13.9 (12.4 – 15.6)

11.9 (10.2 – 13.9)

4.8 (3.7 – 6.1)

VAP - 6.68 (3.0 – 12.7) 9.50 (7.9 – 11.3) 10.1 (7.9 – 12.8) 10.7 (8.4 – 13.4) Overall - CLABSI 12.5

(11.7 – 13.3)9.2

(8.8 – 9.7)7.6

(7.4 – 7.9)6.8

(6.7 – 7.0)4.8

(4.7 – 4.9)CAUTI 8.9

(8.3 – 9.5)6.5

(6.1 – 6.9)6.3

(6.0 – 6.5)6.3

(6.2 – 6.5)5.3

(5.2 – 5.4)VAP 24.1

(22.8 – 25.5)19.5

(18.7 – 20.3)13.6

(13.3 – 14.0)15.8

(15.5 – 16.1)14.7

(14.5 – 14.9)

International Nosocomial Infection Control Consortium (INICC) report, data summary for

2007- 2012, Device-associated module

AJIC published in 2014

Víctor Daniel Rosenthal 1; Dennis George Maki 2; Yatin Mehta 3; Hakan Leblebicioglu 4; Ziad Ahmed Memish 5; Haifaa Hassan Al-Mousa 6; Hu Bijie 7; Carlos Alvarez-Moreno 8; Eduardo A

Servolo-Medeiros 9; Anucha Apisarnthanarak 10; Lul Raka 11; Luis E Cuellar 12; Altaf Ahmed 13; Josephine Anne Navoa-Ng 14; Amani Ali El-Kholy 15; Souha Sami Kanj 16; Ider Bat-Erdene 17;

Wieslawa Duszynska 18; Nguyen Van Truong 19; Maria Marcela Bovera 20; Lucy Chai See-Lum 21; Rosalia Fernandez-Hidalgo 22; Gabriela Di-Silvestre 23; Farid Zand 24; Sona Hlinkova 25; Vladislav Belskiy 26; Hussain Al-Rahma 27; Marco Tulio Luque-Torres 28; Nesil Bayraktar 29; Zan Mitrev 30;

Vaidotas Gurskis 31; Dale Fisher 32; ilham Bulos Abu-Khader 33; Kamal Berechid 34; Arnaldo Rodríguez-Sánchez 35; Florin Horhat 36; Osiel Requejo-Pino 37; Nassya Hadjieva 38; Nejla Ben-

Jaballah 39; Elías García-Mayorca 40; Luis Kushner-Dávalos 41; Srdjan Pasic 42; Luis E. Pedrozo-Ortiz 43; Eleni Apostolopoulou 44; Nepomuceno Mejía 45; May Osman Gamar-Elanbya 46; Kushlani

Jayatilleke 47; Miriam de Lourdes-Dueñas 48; Guadalupe Aguirre-Avalos 49.

Rosenthal, V. D., et alRosenthal, V. D., et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2007- 2012, Device-

associated module" American journal of infection control" American journal of infection control

INICC report – 43 countries- “2007 to 2012”. INICC report – 43 countries- “2007 to 2012”.

Countries included: Argentina, Bolivia, Brazil, Bulgaria, China, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Egypt, Greece, India, Iran, Jordan, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Puerto Rico, Romania, El Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sri Lanka, Sudan, Thailand, Tunisia, Turkey, United Arab Emirates, Uruguay, Venezuela, Vietnam

ICUs: 503

Patients: 605,310

Bed days: 3,338,396

Central Line days: 1,650,901

Ventilator days: 1,197,681

Urinary catheter days: 1,947,650

BSI (n): 7887

VAP (n): 17,605

CAUTI (n): 10,322

Total IAD: 35,814Rosenthal, V. D., et alRosenthal, V. D., et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2007- 2012, Device-

associated module" American journal of infection control" American journal of infection control

HAI rates INICC vs CDC-NHSN (USA)HAI rates INICC vs CDC-NHSN (USA)

INICC 2007–2012

Pooled Mean (95% CI)

U.S. NHSN 2012

Pooled Mean (95% CI)

Medical Cardiac ICU CLABSI 3.5 (3.1 – 3.9) 1.1 (1.0 – 1.1)CAUTI 5.9 (5.4 – 6.4) 2.2 (2.0 – 2.3)VAP 11.5 (10.5 – 12.5) 1.0 (0.8 – 1.1) Medical-surgical ICU CLABSI 4.9 (4.8 – 5.1) 0.9 (0.9 – 1.0)CAUTI 5.3 (5.2 – 5.8) 1.2 (1.2 – 1.3)VAP 16.5 (16.1 – 16.8) 1.1 (1.0 – 1.2) Pediatric ICU CLABSI 6.1 (5.7 – 6.5) 1.4 (1.3 – 1.6)CAUTI 5.6 (5.1 – 6.1) 2.7 (2.5 – 3.0)VAP 7.9 (7.4 – 8.4) 0.8 (0.6 – 0.9) Newborn ICU (1501-2500 g) CLABSI 4.8 (3.7 – 6.1) 0.6 (0.5 – 0.8)VAP 10.7 (8.4 – 13.4) 0.2 (0.1 – 0.5)

Rosenthal, V. D., et alRosenthal, V. D., et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2007- 2012, Device-associated module" American journal of infection control" American journal of infection control

29

EngageEngagePartner with Infection Control, ID expertsIncrease awareness about morbidity and mortality associated with CLABSI Make harm visible

Tell storiesPost # infections

Estimates of opportunity to improve

TEAM FORMATION

ICU Director ICU Nurse Manager

Infection Control Practitioners

Chief Hospital Epidemiologist

Attendings & Residents

Nursing Staff (ICU)

QA/Quality Staff QI experts

Frontline Staff

Infectious Disease experts

Leaders

National Quality Scholars

Form the Dream Team

• Heterogeneous in make up; homogeneous in mind set

• All stakeholders must be included • All RN teams fail because MDs insert lines

• Find a high profile champion

• Get a process owner

Vanderbilt Infection Control & Prevention

Thank You Notes to NICU Staff

Thank You From Thank You From Baby Boy JonesBaby Boy Jones

I have gone 136 days without a bloodstream infection. Keep up the

good work! My Mom left some “kisses” for you! XOXOX

EducateEducate

Educate staff and senior leaders about CDC guidelines

Develop a resource notebookDevelop policies and proceduresCDC guidelines and Fact SheetPower point slides for In-services

Consider a quiz to evaluate provider knowledgeCan use on-line training

EvaluateEvaluate

Outcome measure: CLABSI rateRate, # infections, weeks/months since last infection

Process measures% checklists completed% violations noted# lines removed

Celebrate success

Share the DataShare the Data

CLA-BSI in Trauma

0

1

2

3

4

5

6

7

8

9

2005 2006 2007

Infs

per

100

dev

ice

days

TraumaCDC Benchmark

BSI Bundle

The Check ListThe Check ListAdapt to your own institutionMust be filled out for each line insertionInclude 5 BSI bundle elements

Simpler is betterCan always add elements as you become better at capturing data

LF

Time end (catheter secured):

MR #:

Check if:

Femoral

Internal Jugular

/ / Date:

Type of catheter:

Triple lumen Introducer Swan-Ganz

Insertion Site:

Subclavian

Other (specify):

Pt/Family teaching done Consent obtained

Pre-insertion skin prep (check any used): Alcohol Betadine (povidone-iodine) Chlorhexidine Other (specify):

Describe the circumstances under which this line was placed: Non-emergent Emergent (life-threatening or code situation)

Please file page 2 in patients chart and return top form to the designated location in the ICU.

List all sites where insertion was attempted. Other (specify):

: Time start (1st needle stick): :

How many different needle sticks did the patient receive (number of skin breaks)?

1 Unknown

The provider inserting this line:

* If “No”, was this procedure supervised by someone with least five (5) central lines experience? Yes No Didn’t ask

Yes No

Please use military time (i.e. 1:00 pm is 13:00)

a. Handed-off his/her pager before the procedure? Yes No b. Washed hands immediately prior to procedure? Yes No *

Didn’t ask Didn’t ask Didn’t ask c. Has previously placed at least five (5) central lines?

Describe the level of training of the person who actually inserted the line? Medical Student Intern (PGY-1) Resident (PGY-2+) Fellow Attending

Barrier precautions (check any used): Sterile gloves Sterile gown Mask Sterile towels Full body drape

Side: Right Left

2 3 4 5 6+

Follow-up CXR: Ordered Not ordered (specify reason):

CXR findings (check all that apply): No pneumothorax Pneumothorax (describe action taken): Catheter in good position Catheter position adjusted (describe):

Type of dressing: Bio-occlusive Gauze Other (specify):

Patient tolerated the procedure well? Yes No

Was the sterile field maintained throughout the entire procedure? Yes No

Complications? None Other (describe):

Dressing applied by: Nurse Proceduralist Other (specify):

Nursing Checklist: Central Venous Catheter Insertion

Vanderbilt University Medical Center

RIJ LIJ RSC LSC RF

Guidewire exchange

Placement unsuccessful

MC 2705 (Rev. 06/04)

NOTE: Please use either black or blue ink to complete this form.

Comments:

Vascath

Signature: ______________________________________________ Date: _________________

Indications for use: Pressors Hemodynamic monit. Fluids/blood products Frequent lab draws

Pre-existing infection

Nurse Practitioner

Double lumen

atVanderbilt

Monroe Carell Jr. OR

CCU MICU SICU BICU PCCU NICU

NSICU TICU Other

ExecuteExecute

Hand HygieneRemove Unnecessary LinesUse of Maximal Barrier PrecautionsChlorhexidine for Skin AntisepsisAvoid femoral lines

Hand HygieneHand HygieneEmpower nursing to enforce use of a central line checklist to be sure all processes related to central line placement, including hand hygiene, are executed for each line placement. Include hand hygiene as part of your checklist for central line placement.Keep soap/alcohol-based hand hygiene dispensers prominently placed and make universal precautions equipment, such as gloves, only available near hand sanitation equipment.Post signs at the entry and exits to the patient room as reminders.Initiate a campaign using posters including photos of celebrated hospital doctors/employees recommending hand hygiene.Create an environment where reminding each other about hand hygiene is encouraged.


Start SmallStart SmallSelect the team and the venue. It is often best to start in one ICU. Many hospitals will have only one ICU, making the choice easier.Assess where you stand presently. What precautions are taken presently when placing lines? Is there a process in place? If so, work with staff to begin preparing for changes.Contact your Infection Control Department. Learn about your catheter-related bloodstream infection rate and how frequently the hospital reports it to regulatory agencies.Organize an educational program. Teaching the core principles to the ICU staff will open many people’s minds to the process of change.Introduce the central line bundle to the staff.


One ICU…then the RestOne ICU…then the RestOnce the bundle has been applied to one patient and subsequent shifts, increase utilization to the remainder of the ICU.Engage in additional PDSA cycles to refine the process and make it more reliable.After achieving reduction in CR-BSI in the pilot ICU, spread the changes to other ICUs, and eventually to other places in the hospital where central lines are inserted

…So Use Data


Potential BarriersPotential BarriersFear of change

Use knowledgeUse optimism

Communication breakdownInvolve all stakeholders on the front end

MD and staff partial “buy-in”Supply continuous data to all groupsChanges in rates convert the non-believers


Questions?Questions?

Do remember the Do remember the Reasons for Infections Reasons for Infections are Many but solutions are Many but solutions are few …are few …

47

Health & Medicine

Catheter related infections in ICU