Central Line Related Blood stream Infection (CLR-BSI)

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Central Line Related Blood Stream Infections (CLR-BSI)

The Case for Preventing Central Venous Catheter related Bloodstream Infections.

  • ●Central Venous Catheters (CVCs) are being used increasingly in the inpatient and outpatient setting to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. Infection may spread to the bloodstream and hemodynamic changes and organ dysfunction (severe sepsis) may ensue, possibly leading to death. Approximately 90% of the catheter-related bloodstream infections (CR-BSIs) occur with CVC.
  • ● Forty-eight percent of intensive care unit (ICU) patients in the U.S. have central venous catheters, accounting for 15 million central-venous-catheter-days per year in U.S.-based ICUs. Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that mortality attributable to these infections is between 4% and 20%. Thus, it is estimated that 500 to 4000 U.S. patients die annually due to bloodstream infections.
  • ●In addition, nosocomial bloodstream infections prolong hospitalization by a mean of 7 days.Attributable cost per bloodstream infection is estimated to be between US $3,700 and $29,000. There are no equivalent Canadian figures for burden of illness. (as per literature).
  • Purpose
    • To identify the incidence of Central Venous Line Related Infections within the WRHA ICU's.
    • The monitoring of the incidence over time will identify the magnitude of the problem within a specific area or unit and will enable comparisons between selected ICU's across Canada (Canadian Collaborative - Safer Health Care Now).
    • This should lead to the review of practices occuring at the time of insertion as well as the care processes relating to the maintenance of the catheter dressings.
  • GOAL
    • Eliminate this preventable patient harm.

'Criteria' for Central Line Related Blood stream Infections (CLR-BSI)

Laboratory confirmed bloodstream infection must meet at least one of the following criteria and have occurred in the ICU or within 48 hours of leaving the ICU:

  • Criterion 1:

Patient has a recognized pathogen cultured from one or more blood cultures and the organism cultured from blood is not related to an infection at another site.

  • Criterion 2:

Patient has at least one of the following signs or symptoms:

  • fever (>38 C)
   OR
  • chills
   OR
  • hypotension
   OR
  • Signs of infection of catheter insertion site/tunnel
   PLUS
  • at least one of the following (A or B) below:

a.) Common skin commensal (comtaminant) is cultured from two or more blood cultures drawn on separate occasions. (e.g. diphtheriods, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci).

   OR

b.) Common skin commensal (comtaminant) is cultured from at least one blood cultures from a patient with an intravascular line. (e.g. diphtheriods, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci).

   AND

physician institutes appropriate antimicrobial therapy.

Defintion of Terms for Central Line Related Blood stream Infections (CLR-BSI)

  1. BSI means a blood stream infection that meets the criteria for BSI below.
  • Criteria for BSI:

a. at least one blood culture result includes a pathogenic organism

  • OR

b. at least two blood cultures results from specimens obtained at different times or from specimens drawn at different phlebotomy sites, e.g., left arm and right arm, within a 2 day period include the same type of common skin commensal organism.

  • OR

c. at least one blood culture result includes a common skin commensal organism

  • AND

antibiotic treatment effective against that organism was started on the day that the culture was collected and was continued for greater than 3 days.

    • Definition of bloodstream infections established in this rule are not to be construed as technical medical definitions of BSI, but only as a definition necessary to establish a reporting requirement.

DISCUSSION

Template:Discussion

  1. need to attached or link the rest of the teaching package for this project. TOstryzniuk 18:48, 2 July 2008 (CDT)



Template:Stub TOstryzniuk 19:42, 26 June 2008 (CDT)