Preventing of Hospital Acquired Infection
Cause and Effect Chart – to reduce Catheter Related – Blood Stream Infections
Version 2008-2
Preventing infection: insertion site sepsis, infusate contamination and catheter-related blood stream infections (CR-BSI)
A literature search was performed and the identified papers underwent a rapid review. From this review, key points of information for optimal central vascular catheter care have been summarised below. A formal scientific critique was not performed on the identified papers and therefore there may be limitations to this process.
Central vascular catheters are the leading cause of device-related bacteraemias [1]. The risk increases however with duration of line use, the more CVC manipulations required and the greater the number of infusions – particularly blood transfusions or infusions made up in house. The presence of other pre-existing sites of infection will also increase the risk [2-5].Organisms causing CR-BSI: The majority of microorganisms that cause CR-BSIs are Gram-positive organisms: coagulase negative staphylococci and Staphylococcus aureus (MRSA and MSSA). These organisms originate from the patient’s skin at the insertion site, hub contamination with skin organisms or from the hands of HCWs. Gram-negative organisms causing CR-BSI originate from the patient, the hands of HCWs or infusate contamination where asepsis has not been practiced during the preparation of drugs [4-7]. (Skin organisms can remain viable in dry conditions for months).The entry of microorganisms can be at any manipulation point, i.e. hub/connection, or insertion site. Organisms gaining entry are frequently skin organisms from the HCW or the patient. Organisms from a distal site of infection can travel via the blood and infect the CVC. Once organisms enter the catheter they form biofilm on the surface of the catheter, multiply and eventually break off causing the patient to have the classic signs of a blood stream infection: pyrexia, rigors etc [2, 3, 8, 9].
Successful Strategies to minimise the risk of CR-BSIs include:
· A commitment to excellence in the care of CVCs by all who care for patients with CVCs.
· Only trained competent HCWs performing CVC procedures
· Only using CVCs when it is essential to do so and removing the CVC as soon as practical.
· Using checklists to remind HCWs of the correct process and reducing the risk of lapses at crucial steps
· Using aseptic non-touch technique; chlorhexidine gluconate 2% antiseptic; sterile dressings; decontamination of hubs; using manufacturers’ instructions.
· Optimising system performance by using aids such as insertion check lists, CR-BSI surveillance and use of Bundles; Then using the data generated to analyse performance and adjust and improve systems, performance and outcome [10-13] .
Version 2008 1
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References:
1. Coello, R., et al., Device-related sources of bacteraemia in English hospitals--opportunities for the prevention of hospital-acquired bacteraemia. J Hosp Infect, 2003. 53(1): p. 46-57.
2. Morales, M., et al., Biofilm: the microbial "bunker" for intravascular catheter-related infection. Support Care Cancer, 2004. 12(10): p. 701-7.
3. Pascual, A., Pathogenesis of catheter-related infections: lessons for new designs. Clin Microbiol Infect, 2002. 8(5): p. 256-64.
4. O'Grady, N.P., et al., Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disese Control and Prevention, US. Pediatrics, 2002. 110(5): p. e51.
5. Maki, D.G. and C.J. Crnich, Line sepsis in the ICU: prevention, diagnosis, and management. Semin Respir Crit Care Med, 2003. 24(1): p. 23-36.
6. Mermel, L.A., et al., Guidelines for the management of intravascular catheter-related infections. J Intraven Nurs, 2001. 24(3): p. 180-205.
7. Vonberg, R.P. and P. Gastmeier, Hospital-acquired infections related to contaminated substances. J Hosp Infect, 2007. 65(1): p. 15-23.
8. Crump, J.A. and P.J. Collignon, Intravascular catheter-associated infections. Eur J Clin Microbiol Infect Dis, 2000. 19(1): p. 1-8.
9. Raad, I., Intravascular-catheter-related infections. Lancet, 1998. 351(9106): p. 893-8.
10. O'Grady, N.P., et al., Patient safety and the science of prevention: the time for implementing the Guidelines for the prevention of intravascular catheter-related infections is now. Crit Care Med, 2003. 31(1): p. 291-2.
11. Pratt, R.J., et al., epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect, 2007. 65 Suppl 1: p. S1-64.
12. Berenholtz, S.M., et al., Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med, 2004. 32(10): p. 2014-20.
13. Warren, D.K., et al., A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol, 2006. 27(7): p. 662-9.