Central Line Related Blood stream Infection (CLR-BSI): Difference between revisions
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==Frequently asked questions== | ==Frequently asked questions== | ||
#'''If a patient in an ICU has a temporary or tunneled hemodialysis catheter, is that device counted as a central line in the central line days?''' | #'''If a patient in an ICU has a temporary or tunneled hemodialysis catheter, is that device counted as a central line in the central line days?''' | ||
''If a line meets the defintion of what is a central line, then it should be counted. The only exception to this would be an implanted device that is not used. In this situation, the line would only be counted beginning on the first day that it is accessed (e.g., physician orders that the port-a-cath be flushed). Then it would be counted every day therafter.'' | *''If a line meets the defintion of what is a central line, then it should be counted. The only exception to this would be an implanted device that is not used. In this situation, the line would only be counted beginning on the first day that it is accessed (e.g., physician orders that the port-a-cath be flushed). Then it would be counted every day therafter.'' | ||
#'''Do central lines include the following: implantable-ports, non tunneled TLC, Swan Ganz catheter, tunneld-Borviac, Groshong, Quinton, Hickman, ASHE catheter, PICC lines? If yes would they be counted in the central line days for that unit?''' | #'''Do central lines include the following: implantable-ports, non tunneled TLC, Swan Ganz catheter, tunneld-Borviac, Groshong, Quinton, Hickman, ASHE catheter, PICC lines? If yes would they be counted in the central line days for that unit?''' | ||
''Yes to all of the above if they meet the definition. Central lines are not defined by the type of device.'' | *''Yes to all of the above if they meet the definition. Central lines are not defined by the type of device.'' | ||
#'''Is a dialysis catheter considered a central line since it isn't used for infusion?''' | #'''Is a dialysis catheter considered a central line since it isn't used for infusion?''' | ||
''A dialysis catheter is considered a central line if it meets the definition of a central line. It is used for infusion of the patient's own blood. '' | *''A dialysis catheter is considered a central line if it meets the definition of a central line. It is used for infusion of the patient's own blood. '' | ||
#'''Are permanent shunts and balloon pumps considered central lines?''' | #'''Are permanent shunts and balloon pumps considered central lines?''' | ||
''Yes if they meet the definition of a central line. Central lines are not defined by type of device.'' | *''Yes if they meet the definition of a central line. Central lines are not defined by type of device.'' | ||
#'''If a patient is admitted to the ICU with a central line in place, is it counted in the central line days''' | #'''If a patient is admitted to the ICU with a central line in place, is it counted in the central line days''' | ||
''Yes'' | *''Yes'' | ||
#'''Clarify the last sentence of the definition for CLR-BSI that reads, "If the time interval was longer than 48 hours, there must be compelling evidence that the infection was related to the vascular acess device."''' | #'''Clarify the last sentence of the definition for CLR-BSI that reads, "If the time interval was longer than 48 hours, there must be compelling evidence that the infection was related to the vascular acess device."''' | ||
''This means only that if the time interval between the removal of the line and the onset of bloodstream infection (BSI) is greater than 48 hours, the BSI should not be considered central line-associated unless there is evidence that is was related to this device.'' | *''This means only that if the time interval between the removal of the line and the onset of bloodstream infection (BSI) is greater than 48 hours, the BSI should not be considered central line-associated unless there is evidence that is was related to this device.'' | ||
#'''What if: a patient had a central line inserted in the ICU; 6 days later the patient has a positive blood culture; and the patient meets the definition for laboratory confirmed bloodstream infection. Would this patient be counted as a Central Line Related blood stream Infection (CLR-BSI)?''' | #'''What if: a patient had a central line inserted in the ICU; 6 days later the patient has a positive blood culture; and the patient meets the definition for laboratory confirmed bloodstream infection. Would this patient be counted as a Central Line Related blood stream Infection (CLR-BSI)?''' | ||
''If the line was not discontinued, it would be counted as a CLR-BSI. If the line were to be discontinued on day 4 or earlier, it would not be counted as a CLR-BSI.'' | *''If the line was not discontinued, it would be counted as a CLR-BSI. If the line were to be discontinued on day 4 or earlier, it would not be counted as a CLR-BSI.'' | ||
#'''How do you determine which unit to "credit with a bloodstream infection? E.G., on May 2nd the patient is in the medical ICU; on May 3 the patient is transferred to the coronary care unit; symptoms develop on May 4th. Which unit is "credited"?''' | #'''How do you determine which unit to "credit with a bloodstream infection? E.G., on May 2nd the patient is in the medical ICU; on May 3 the patient is transferred to the coronary care unit; symptoms develop on May 4th. Which unit is "credited"?''' | ||
''The patient is followed for 48 hours AFTER TRANSFER to another unit. If a BSI develps within that 48 hour period, the original unit is "credited" with the infection.'' | *''The patient is followed for 48 hours AFTER TRANSFER to another unit. If a BSI develps within that 48 hour period, the original unit is "credited" with the infection.'' | ||
#'''What is "appropriate" antimicrobial therapy"?''' | #'''What is "appropriate" antimicrobial therapy"?''' | ||
''This is not defined. If an antibiotic is appropriate for the microoganism identified, for example, not resistant or used for that microorganism, then it is appropriate.'' | *''This is not defined. If an antibiotic is appropriate for the microoganism identified, for example, not resistant or used for that microorganism, then it is appropriate.'' | ||
#'''what should be done if a device-day is not counted?''' | #'''what should be done if a device-day is not counted?''' | ||
''Days should not be skipped. If days are not recorded (say on weekends),then the staff charts should be reviewed and staff interviewed to determine what the counts were at the appropriate time period. '' | *''Days should not be skipped. If days are not recorded (say on weekends),then the staff charts should be reviewed and staff interviewed to determine what the counts were at the appropriate time period. '' | ||
#'''A patient with a dialysis catheter is in one the ICU's under surveillance for CLR-BSI. If this patient's dialysis catheter is only accessed in the dialysis center, are the central line days for this patient counted in the ICU's central line count days?''' | #'''A patient with a dialysis catheter is in one the ICU's under surveillance for CLR-BSI. If this patient's dialysis catheter is only accessed in the dialysis center, are the central line days for this patient counted in the ICU's central line count days?''' | ||
''No. In this instance, the central line days would not be counted in the ICU central line day count.'' | *''No. In this instance, the central line days would not be counted in the ICU central line day count.'' | ||
#'''A aptient with dialysis catheter is in one of the ICU's under surveillance for CLR-BSI. Someone from the dialysis center comes to the ICU to perform the dialysis. Will the central line days for this patient be counted in the ICU's central line day count?''' | #'''A aptient with dialysis catheter is in one of the ICU's under surveillance for CLR-BSI. Someone from the dialysis center comes to the ICU to perform the dialysis. Will the central line days for this patient be counted in the ICU's central line day count?''' | ||
''Yes. In this instance, the central line days would be counted in the ICU's central line day count.''[[User:TOstryzniuk|TOstryzniuk]] 15:08, 11 July 2008 (CDT) | *''Yes. In this instance, the central line days would be counted in the ICU's central line day count.''[[User:TOstryzniuk|TOstryzniuk]] 15:08, 11 July 2008 (CDT) | ||
==Discussion== | ==Discussion== | ||