Central LineAssociated Blood Stream Infections CLABSI The Impact

Central Line-Associated Blood Stream Infections (CLABSI) The Impact of your Practice PRESENTED BY: Henriette Blanchard R. N, BSN, Dotter Interventional Radiology, OHSU, Portland, Oregon

Objectives 1. CLABSI incidence and burden 2. CLABSI Standards of Care 3. OHSU experience with CLABSI quality improvement initiative 2

Central Line - Associated Blood Stream Infection (CLABSI) Definition: A laboratory confirmed blood stream infection (not related to an infection at another site) where a central line was in place within 48 hour period before the development of a bloodstream infection (BSI) Haddadin Y, (2018) 3

HAI Estimates Occurring in US Acute Care Hospitals, 2011 Magill, S et al, . ( 2014) 4

CLABSI – Did you know? • Estimated 30, 100 / year in ICU’s • Mortality rate 12 -25 % • Cost per episode of care $3, 700 $36, 000 • National CLABSI decrease of 50 % between 2008 -2016 Health Research & Educational Trust. (2017)

Standardized Infection Ratio (SIR) Observed number of Infections (O) Predicted number of infections (P) National Center for Emerging Zoonotic Infectious Diseases, (2018) 6

CLABSI Reduction and Location Centers for Disease Control and Prevention, 2016)

CLABSI Reduction Health Research & Educational Trust, (2017)

CLABSI Prevention Bundles • Insertion bundle: procedural pause, hand hygiene, aseptic technique, optimal site selection chlorhexidine skin prep and maximum sterile barrier precautions • Maintenance bundle: CVC dressing changes, tubing changes, IV fluid changes, daily review of line necessity with timely removal Health Research & Educational Trust, (2017) 9

“Houston, we have a problem. . . ” 10

What did our observations reveal and what did we do about it? Pre Procedure No hat/crown Facial hair Wearing bling Did her majesty use a CHG wipe? Photos courtesy of my personal archive 11 Intra Procedure

Reasons for Premature Dressing Changes • 1. Bleeding from site: Dressing changed < 7 days • 2. Dressings not adhering well: Dressing changed < 7 days • 3. Dressings not applied correctly: Dressing changed < 7 days • 4. Dressings, sutures or site choice uncomfortable or painful for patient: Dressing changed < 7 days 12

Observations? 13

Vertical Mattress Suture Technique 2. 0 VICRYL SUTURE Dissolvable 14

Our New Quality Improvement Goal 15

OHSU House-Wide CLABSI SIR by Quarter 16

CDC Recommendations • Educate healthcare personnel • Periodically assess knowledge and adherence to guidelines • Designate only trained personnel for insertion and maintenance • Ensure appropriate nursing staffing levels 17

What’s your Attitude to CLABSI’s? • Inevitable 18 Major Catastrophe

Conclusion • What is CLABSI • Incidence and burden of CLABSI • CLABSI bundles • A brief description of our quality improvement initiative • Reflect on your practice • Inspired you to learn more about CLABSI 19

Your practice makes a difference…. Everyday, you touch the lives of people who are at their weakest, frightened and uncertain of what is about to happen to them. Getting an avoidable hospital infection is the last thing on their mind. Be your patient’s advocate, especially when they don’t even know they need one.

References • • • 21 Centers for Disease Control and Prevention. (2011). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Retrieved from https: //www. cdc. gov/infectioncontrol/guidelines/bsi Centers for Disease Control and Prevention. (2016). Healthcare-associated Infections in the United States, 2006 -2018: A Story of Progress. Retrieved from https: //www. cdc. gov/hai/surveillance/data-reports/data-summary-assessing-progress. html Centers for Disease Control and Prevention. (2018). Healthcare–associated Infections (HAI). HAI Data and Statistics. Retrieved from https: // www. cdc. gov/hai/surveillance/index. html Haddadin Y, Regunath H. Central Line Associated Blood Stream Infections (CLABSI) [Updated 2017 Mar 28]. In: Stat. Pearls [Internet]. Treasure Island (FL): Stat. Pearls Publishing; 2018 Jan-. Retrieved from : https: //www. ncbi. nlm. nih. gov/books/NBK 430891 Health Research & Educational Trust. (2017). Central Line-Associated Infections (CLABSI) Change Package: 2017 Update. Chicago, IL. Retrieved from http: //www. hret-hiin. org/Resources/clabsi/17/central-line-associated-bloodstream-infection-clabsi-change-package. pdf Magill, S. S. , Edwards, J. R. , Bamberg, W. , Beldavs, Z, . Dumyati, G. , Kainer, M. A, …et al (2014). Multistate Point Prevalence Survey of Health Care Associated Infections. The New England Journal of Medicine, 370: 1198 -208