Central line associated blood stream infections.pptx

Crbsi

1. Central line associated blood stream infections Rasangi suraweera

2. contents Definition Central line uses Types of central lines Pathogens causing pathophysiology Risk factors Case definition Evaluation Aseptic non touch technique treatment

3. A central line associated blood stream infection is defined as a laboratory confirmed blood stream infection not related to an infection at another site that develops within 48 hours of central line placement..

4. Why are they important? Central line-associated bloodstream infections (CLABSIs) result annually in: 84,551 to 203,916 preventable infections. 10,426 to 25,145 preventable deaths. $1.7 to $21.4 billion avoidable costs.

5. Why do we need central lines? Central venous pressure monitoring Resuscitation requiring high volume or flow Emergency venous access Inability to obtain peripheral venous access Repetitive blood sampling Administration of Hyperalimentation [ parentral nutrition esp when long term] Concentrated fluids Chemotherapy

6. Drugs that are prone to cause phlebitis in peripheral veins Calcium chloride,Chemotherapy Hypertonic saline,Potassium chloride ( KCl ) Amiodarone Vasopressors (for example, epinephrine, dopamine) Long-term intravenous antibiotics Insertion of transvenous cardiac pacemakers Hemodialysis or plasmapheresis Insertion of pulmonary artery catheters Plasmapheresis Peripheral blood stem cell collections Dialysis Frequent blood draws No peripheral access present in face of the need for intravenous therapy

7. Two types : Tunneled catheters are implanated surgically ( by creating a subcutaneous track before entering vein ) into the internal jugular,subclavian or femoral vein for long term ( weeks to months ) use for chemotherapy or hemodialysis Non tunneled catheters more commonly used are inserted percutaneously and account for most CLABSIs

8. Pathogens causing The order of selected pathogens causing CLABSI are as follows: Gram positive organisms coagulase negative staph,enterococci ,staph aureus Gram negative klebsiella ;Enterobacter, pseudomonas, ecoli , acientobacter , Candida species

9. pathophysiology within 7 to 10 days of venous catheter placement bacteria on the skin surface of the catheter from the skin exit site towards the intravascular catheter.tunnelled catheters have a cuff that causes a fibrotic reaction around the catheter creating a barrier to bacterial migration. Beyond ten days are usually caused by contamination of the hub ( intraluminal ) typically from a health care providers contaminated hands but rarely from a host Due to breach of standard septic precaution to access hub. Heamtagenous seeding of bacteria from a contaminated infusate or another source.

10. Host factors risk factors Chronic illness ( hemodialysis,malignancy.gastrointestinal disorders,pulmonary hypertension) Immune suppressed states( organ transplant ,diabetes melitus ) Malnutrition Total parentral nutrition, Extremes of age Loss of skin integrity burns Prolonged hospitilisation before line insertion

11. Risk factors site Femoral catheters are associated with the highest risk of CLABSi followed by the internal jugular and subclavian catheters. Femoral catheters are also associated with a higher rate of deep venous thrombosis

12. Risk factors others Catheter type (single vs multi lumen,antibiotic and antinfective ) conditions of insertion( ultrasound,sterile ) emergent versus elective ,use of full barrier precuations , catheter care and skill of the operator

13. History Fever and chills Atypical presentations altered mental status,hypotension,lethargy ,fatigue. signs of inflammation of tunneled catheters with inspection and palpation of the subcutaneous track is important

14. CLABSI case definition (must meet one of three criteria): Criterion 1: Patient has a recognised pathogen cultured from one or more blood cultures AND 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), chills, or hypotension AND Signs and symptoms and positive laboratory results are not related to an infection at another site AND Common skin contaminant* is cultured from two or more blood cultures drawn on separate occasions

15. Criterion 3: Patient 1 year of age or under has at least one of the following signs or symptoms: fever (>38°C core) hypothermia (less than 36°C core), apnoea , or bradycardia, AND Signs and symptoms and positive laboratory results are not related to an infection at another site AND Common skin contaminant* is cultured from two or more blood cultures drawn on separate occasions

16. evaluation

17. Bundle of five critical care components Select the best insertion site . Perform hand hygiene. Use maximal sterile barrier precautions. Prepare the insertion site with >0.5% chlorhexidine with alcohol. Promptly remove nonessential catheters.

18. Aseptic non touch techqniue Aseptic Non Touch Technique (ANTT®) is based upon a set of foundation principles and safeguards set out in the ANTT® Clinical Practice Framework.  Aseptic technique is a procedure used to prevent the spread of infection. It aims to prevent microorganisms on hands, surfaces and equipment from being introduced to susceptible sites. Aseptic technique protects patients during invasive clinical procedures by employing infection control measures that minimise , as far as practicably possible, the presence of pathogenic organisms

19. When to remove the catheter Prompt removal of catheter when the clinical suspicion is high sometimes before the CLABSI diagnosis is proven

20. Treatment of CLABSI

21. references Preventing and Managing Central Line-Associated Bloodstream Infections Life in the fast lane Prevention of Central Line-Associated Bloodstream Infections Taison Bell and Naomi O’Grady Critical Care Medicine Department, National Institutes of Health. Treatment of central line-associated bloodstream infections Jérémy Guenezan ,  Bertrand Drugeon ,  Nicolas Marjanovic  &  Olivier Mimoz