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Prevention Of Catheter associated blood stream infections by Mr. Shivraj
- 1. Prevention of CLABSI Preparedby- Shivraj Barsole 3rd semester RVCON Microteaching on-
- 2. Introduction CLABSI (centralline associated blood- stream infection)is the most serious HAI. It is preventable through complete adherence to aseptic protocols, surveillance, and management measures
- 4. Definition 1. CLABSI isa laboratory confirmed bloodstream infection in which central line is in place within 48 hours before the development of the bloodstream infection –haddadin and ragunath, 2017
- 6. Causes • Coagulase –negative staphylococci • Enterococci – (vancomycin- resistant enterococci ) • MRSA – positive staphylococcus aureus • Klebsiella • Pseudomonus • Acinetobacter • Escheichia coli
- 7. Risk factor Immunocompromisedstate- Neutrogena, diabetes mellitus, and bone marrow transplant or organ transplant recipient Prolonged hospitalization before catheter insertion Total parental nutrition and dialysis Chronic illness Extremes of age Burns and other skin pathology
- 8. Pathophysiology Breach in asepticprecaution at the time of insertion Hub contamination through Breach in aseptic handling of catheter Infusing contaminated fluids Migration of organism from the contaminated skin through the exit point of the lumen of catheter
- 9. Clinical manifestation Feverwith chills Neutropenia Hypotension Cont…
- 10. Pus ordrainage around exit site Redness, induration, and swelling at insertion site Pain Poor or no return blood flow from venous access
- 11. Management After takingblood culture, empirical antibiotic therapy may be started On receiving culture report based on the sensitivity, systemic antibiotic therapy should be started and may be given for 2 week duration If CLABSI is proven, the catheter can be removed and tip sent for culture and sensitivity Cont…
- 12. In hemodialysis, topicaland systemic antibiotic therapy may be initially attempted In case of tunneled catheter getting infected, it needs to be removed
- 13. Prevention The societyfor health care epidemiology of America and infectious diseases society of America (SHEA / IDSA) guidelines are give as follows :
- 14. Classification • Catheter maintenancebundle • At the time of central line insertion
- 15. • CLABSI/ CRBSIprevention: At the time of central line insertion Perform hand hygiene with soap and water of foam or alcohol-based gels Ensure adherence to infection control protocol while central line insertion using a checklist Use of gloves does not prevent hand hygiene Avoid using the femoral vein for central venous access in obese adult patients Do not use peripheral inserted CVCs as a strategy to reduce risk of CLABSI Cont…
- 16. Use maximumsterile barrier precautions during CVC insertion, which include wearing sterile PPE and draping the whole body with a large sterile sheet For smooth complication-free internal jugular catheter insertion, use ultrasound guidance Apply an alcohol based or chlorhexidine antiseptic solution for skin preparation before puncture
- 17. Maintain appropriatenurse-patient ratio Before touching the patient and the central venous access, perform hand hygiene Catheter hubs, needleless connectors, and injection ports need to be disinfected by using sterile swab and 70 % alcohol or providing-iodine /chlorhexidine based solution before accessing the central line Apply mechanical friction for no less than 5 seconds before touching any part of tubing hubs or connectors or ports to reduce contamination • CLABSI/ CRBSI prevention: Catheter maintenance bundle Cont…
- 18. Use centralvascular access to the period most necessary. Remove unwanted extension catheters. Regularly assess the need for central venous access and if not accessory remove it at the earliest. For non tunneled catheter, change the soiled dressing at once, if there is gauze dressing, change the dressing with all aseptic precautions once in 2 days. In case of transparent dressing, it can be changed once in 5 to 7 days time.
- 19. Blood sets haveto changed in 24 hours time. Iv sets used for infusing lipid emulsion, propofol, need to be changed in 12 hours time . Iv lines can be changed at least within 96 hours. Use antimicrobial locks.
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- 22. Do you have anydoubt ???
- 23. What isthe full form of CLABSI ? what signs and symptoms will occur after CLABSI ? Which are two key times to prevent CLABSI ? QNA
- 24. Bibliography Suresh k.sharma and s. Madhavi.brunner and suddharth’s medical surgical nursing.south Asian edition.volume 2 .published by Wolters kluwer .Delhi.pg no. 2149-2150 Anju dhir .textbook of applied microbiology including infection control and safety.2nd edition. CBS publishers and distributors, pvt Ltd.pg no. 341-344
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