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 Blood stream Infection (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.
    • ICU associated BSI: BSI is not present on admission to ICU. The patient must have been in the ICU for 48 hours for the BSI to be considered ICU associated, unless compelling evidence suggests the infection was ICU associated.
    • BSI onset during ICU stay or within 48 hours of leaving the ICU.
  1. CLis Central Line. A CL is a vascular access catheter that passes through or has a tip ending at or close to the heart or in one of the great vessels.

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)