Central Line Related Blood stream Infection (CLR-BSI)

From CCMDB Wiki
Jump to navigation Jump to search

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

AND

  • at least one of the following (A or B) below:

a.) Common skin commensal (contaminant) 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.

Definition of Terms

CL means 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.

Great vessels include:

  • aorta
  • pulmonary artery
  • superior vena cava
  • inferior vena cava
  • brachiocephalic vein
  • internal jugular vein
  • subclavian vein
  • external iliac vein
  • commom femoral vein

Central Lines include:

  • subclavian vein catheter
  • internal jugular vein catheter
  • PCII (Peripherally Inserted Central Catheter)
  • Swan-Ganz (pulmonary artery) catheter
  • Brovic
  • Groshong
  • Hickman
  • Dialysis catheter
  • introducer for temporary pacing wire

Not counted as Central Lines:

  • arterial catheters inserted into an artery
  • pacemaker wire-permanent

BSI means blood stream infection

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

Criteria for Blood stream Infection (BSI):

  • At least one of the following:

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 culturee 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.

Common skin commensal

  • Common skin commensal means microorganisms that are commonly found on the skin and often indicate contamination of the blood culture media rather than identification of a pathogenic organism when identified in blood culture tests. these include coagulase negative staphylococci, proprionbacterium species, corynebacterium species, diphtheroids, bacillus species and mirococcus species.

Central Line Days (CLD's)

  • How do we count?

a.) Count the number of patients with a central line in place at the time of the count.

b.) Perform count at the same time each day, within 1 hour before or after the target time, during the reporting period.

c.) A patient with two or more central lines in place at the time of the count is counted as one patient with a central line on that day.

d.) Count the total number of patients who are in the ICU each day at the time of the line counts.

e.) Every MONDAY, a copy of the counts from the previous week (Monday to Sunday), will be faxed to the following number: 787-2823 ATTENTION Pagasa Torres.

f.) A copy of the line count form will be kept on file by the unit manager at each site.

Sample of Line Count Form.....


Notes

  • 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.

Discussion

  1. need to attached or link the rest of the teaching package for this project. TOstryzniuk 18:48, 2 July 2008 (CDT)
  2. Sample of LINE COUNT FORM needs to be uploaded here.TOstryzniuk 14:34, 11 July 2008 (CDT)

Template:Discussion Tina Says.... (the antibiotic part of the definition is problematic because:

  • it would exclude a patient where, after the culture comes back, it is found out that the antibiotic was not in fact effective.
  • it might loose a patient whose antibiotic is started but for whatever reason is discontinued.
  • are there, or are there anticipated to be, any antibiotics whose course will legitimately be less than 3 days
  • it would exclude patients who are already on an antibiotic and remain on the same one due to a BSI)

Trish says:

  • Might want to send this question to Bruce Light or Dean Bell? The criteria is what the Canadian Collaborative and Safer Health Care now is using.TOstryzniuk 14:13, 11 July 2008 (CDT)

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