CRBIS.pptx

CRBSI

1. P revention O f C atheter R elated B lood S tream I nfections Prepared by SDU March 2022 CRBSIs

2. Objectives To define CRBSI To discuss different types of catheters To discuss the bundle approach on how to prevent and control CRBSI

3. What is CRBSI Is defined as the presence of bacteremia originating from an Intravenous catheters.

4. Types of Catheters Central Venous catheter Peripheral venous catheter Peripheral arterial catheter Umbilical catheter Tunneled catheter Non –Tunneled catheter Porta Catheter/implanted port

5. Tunneled Central Line Non tunneled central Line Implanted Port Umbilical PICC

6. Peripheral Arterial Catheter Peripheral Venous catheter

7. Strategies for Prevention of Catheter- Related Infections Education, Training and Staffing Selection of Catheters and Sites Hand Hygiene and Aseptic Technique Patient Cleansing Catheter Securement Devices Antimicrobial/Antiseptic Impregnated Catheters and Cuffs Antibiotic/Antiseptic Ointments Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush and Catheter Lock Prophylaxis Guidelines on the Prevention of Intravascular Catheter - Related

8. Education, Training and Staffing Educate healthcare personnel regarding : indications for intravascular catheter proper procedures for the insertion and maintenance of intravascular catheters measures to prevent intravascular catheter- related infections

9. Selection of Catheter and Sites Peripheral catheters & midline catheters Use upper extremity site for catheter insertion . Remove peripheral venous catheters if the patients develops signs of phlebitis, infection, or a malfunctioning catheter .

10. Avoid the use of steel needles for the administration of fluids and medication. Evaluate the catheter insertion site daily by palpation through the dressing to discern tenderness and by inspection if a transparent dressing is in use. Selection of Catheter and Sites

11. B) Central venous catheter Use a CVC with a minimum number of ports or lumens essential for the management of patient. Promptly remove the catheter that is no longer essential. Catheters inserted during a medical emergency to be replaced as soon as possible within 48 hours (when adherence to aseptic technique cannot be ensured).

12. Hand Hygiene and Aseptic Technique . Hand Hygiene is the single most effective precaution for prevention of infection transmission between patients and staff

13. Hand Hygiene and Aseptic Technique Hand hygiene should be performed before and after Accessing the catheter to draw blood or administer medications Dressing change Changing IV tubing and devices Palpating catheter insertion site

14. Wear clean gloves for the insertion of peripheral intravascular catheters. Sterile gloves should be worn for the insertion of arterial and central line catheters. Use sterile gloves before handling the new catheter when guide wire exchanges are performed. Wear either clean or sterile gloves when changing the dressing on intravascular catheters. Hand Hygiene and Aseptic Technique

15. Maximal Barrier Protection Use maximal sterile barrier precautions including the cap, mask, sterile gown, sterile gloves and sterile full body drape for the insertion of CVCs, PICC or guide wire exchange

16. SKIN PREPARATION Use proper skin antisepsis A) Peripheral venous catheter insertion 70% alcohol, chlorhexidine gluconate B) CVC and Arterial catheters Chlorhexidine gluconate (CHG) 0.5% chlorhexidine gluconate (CHG) (preferably 2%) in 70% Alcohol for patients > 2 months old unless there is a documented contraindication to CHG Povidone iodine Alcohol 70%

17. SKIN PREPARATION Scrub back and forth with CHG with friction for 30 seconds Allow to air dry completely before puncturing the site ( ~ 2 minutes) . Don't wipe, fan or blot. NB. For groin preparation; scrub 2 minutes and allow to dry for 2 minutes

18. Catheter site dressing Regimens Use either sterile gauze or sterile transparent, semi-permeable dressing to cover the catheter site. If the patient is diaphoretic or if the site is bleeding or oozing, use gauze dressing until this is resolved. Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled.

19. Catheter site dressing Regimens Do not use topical antibiotic ointment or creams on insertion sites except for dialysis catheters. Do not submerge the catheter or catheter site in water. The catheter and connecting device are protected with an impermeable cover during the shower.

20. Catheter site dressing Regimens For proper dressing change Use aseptic technique with clean or sterile gloves Perform proper skin antisepsis as part of the site care procedure: The preferred skin antiseptic agent is > 0.5% CHG (preferably 2%) in 70% alcohol solution. If there is a contraindication to alcoholic chlorhexidine solution, povidone iodine or 70% alcohol may also be used. Allow any skin antiseptic agent to fully dry prior to dressing placement.

21. Write the date on the dressing If gauze dressing : changes at least every two days NB. A gauze dressing underneath a transparent dressing is considered a gauze dressing and changed at least every 2 days. If transparent semi permeable dressing, change at least every 7 days NB. If the patient is diaphoretic or if the site is bleeding or oozing, use a gauze dressing until this is resolved.

22. Immediately replace dressings that are wet, soiled or dislodged Dressing Replacement

23. Catheter site dressing Regimens Monitor the catheter site visually when changing the dressing or by palpation through an intact dressing on a regular basis. Encourage patients to report any changes in their catheter site or any new discomfort

24. Patient Cleansing Use a 2% chlorhexidine wash for daily skin cleansing to reduce CRBSI For Adult and Pediatric ICUs Only ; Bathe ICU patients over 2months of age with a chlorhexidine preparation ( on daily basis according to the unit schedule)

25. Clinical trials of daily bathing with no-rinse, 2% CHG impregnated washcloths Vs soap and water bathing. It was found that patients receiving the CHG intervention were significantly less likely to acquire a primary BSI Daily cleansing of ICU patients with no-rinse 2% CHG impregnated washcloth may be a simple, effective strategy to reduce CLABSI .

26. Catheter Securement Devices Use a suture less securement device to reduce the risk of infection for intravascular catheters.

27. Antimicrobial/Antiseptic Impregnated Catheters and Cuffs Use a chlorhexidine/silver sulfadiazine or minocycline/ rifampin -impregnated CVC in patients whose catheter is expected to remain in place >5 days.

28. Systemic Antibiotic Prophylaxis Not recommended

29. Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush and Catheter Lock Prophylaxis Use prophylactic antimicrobial lock solution in patients with long term catheters who have a history of multiple CRBSI despite optimal maximal adherence to aseptic technique .

30. Anticoagulants Do not routinely use anticoagulant therapy to reduce the risk of catheter-related infection in general patient populations.

31. Replacement of Catheters Replace peripheral arterial and venous catheter ,CVC,PICC when clinically indicated . Remove peripheral arterial and venous catheter ,CVC,PICC as soon as its no longer needed Replace disposable/reusable transducers along with other components of the system( including the tubings , continuous flush device, pressure bag and flush solution) at 96 hours interval. Keep all components of pressure monitoring system including flush solution as sterile Minimize the number of manipulations in the pressure monitoring system

32. Proper replacement of administration sets used for continuous infusion If propofol is administrated  Change tubing every 6-12 hours or when the vial is changed If blood or blood products or fat emulsions are administrated  Change tubing every 24 hours. For continuous infusions other than blood, blood products or fat emulsions  NO more frequently than every 4 days, but at least every 7 days. Replacement of administration set

33. Needleless Intravascular Catheter System Change the needleless components at least as frequently as the administration set. Change the needleless connectors no more frequently than every 72 hours or according to manufacturer’s recommendations. Ensure that all components of the system are compatible to minimize leaks and breaks in the system Use a needleless system to access IV tubing Use a split septum valve (Q- syte ) Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, or 70% alcohol) and accessing the port only with sterile devices.

34. Scrub the access port or hub Catheter hubs, needles connectors, and injection ports should be disinfected before accessing the catheter . Friction and a twisting motion should be used for at least 15 seconds immediately prior to each use with an appropriate antiseptic (> 0.5% chlorhexidine (preferably 2%) in 70% alcohol solution, povidine iodine, or 70% alcohol). Alcoholic chlorhexidine may have additional residual activity compared with alcohol for this purpose. Let the antiseptic to air dry.