Preventing Central Line Blood Stream Infections Essay Example

Preventing Central Line Blood Stream Infections Essay Preventing Central Line Blood Stream Infections 4010 Scholarly Paper LeTanya V. Cintron Huron School of Nursing 09/29/2010 There are a variety of intravascular devices used for vascular access and they are becoming more common in today’s healthcare system, mainly due to their convenience. Whether it’s a short-term triple lumen central venous catheter or an arterial catheter for hemodynamic monitoring or long term venous access for inpatient or outpatient use for fluids, TPN, chemo, home antibiotics or hemodyalisis; central venous catheters are here to stay. Their convenience and ease of access makes them almost a necessity in patient care, but at what cost? Regardless of their purpose and ease of use, it is up to us as nurses and healthcare workers to recognize when patients are at risks for infection due to venous catheter use. In this paper, I will identify guidelines to prevent blood infections from central lines. The Joint Commission has identified the prevention of central line-associated bloodstream infections as one of its safety goals. They hold importance to educating all staff and workers that are involved in managing and caring for central lines. They emphasize in infection prevention. Patient and family education is also key; especially for individuals with long term lines at home. The Joint Commission also promotes the use of a catheter checklist and a standardized protocol for central venous catheter insertion with emphasis on hand hygiene prior to catheter insertion or manipulation, use of a central line bundle, and the â€Å"use [of] a standardized protocol for sterile barrier precautions during central venous catheter insertion† (TJC, 2009). A peer reviewed article written by Maki, Kluger and Crnich, shows that higher blood stream infection rates for intra vascular devices used 100 days or less were found in surgically implanted cuffed and tunneled all-purpose CVCs, and cuffed and tunneled hemodialysis catheters (2010). We will write a custom essay sample on Preventing Central Line Blood Stream Infections specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Preventing Central Line Blood Stream Infections specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Preventing Central Line Blood Stream Infections specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Lower blood stream infection rates were found in temporary non-cuffed hemodialysis catheters, non-cuffed but tunneled CVCs, non-cuffed and non-tunneled CVCs, peripheral subcutaneous central venous ports, central venous ports, outpatient PICCs, intra-aortic balloon pumps, chlorohexidine-silver-sulfadiazine-impregnated CVCs, inpatient PICCs, arterial catheters, midline catheters, and peripheral IV catheters to name a few (Maki, Kluger Crnich, 2010). These results differed when studying IVD’s that were used up to 1000 days. These results shower higher blood stream infections in peripheral IV catheters placed by surgical cut down, peripheral steel needles, intra-aortic balloon pumps, short-term non-cuffed hemodialysis catheters, and silver-impregnated Lower rates were now shown with non-cuffed, non-tunneled multi-lumen CVCs, inpatient PICC, arterial catheters, chlorhexidine-silver-sulfadiazine-impregnated CVCs, cuffed and tunneled all-purpose Hickman-like CVCs, long-term cuffed and tunneled hemodialysis CVCs, outpatient PICC, peripheral IV catheters, peripheral central venous subcutaneous ports, and central venous ports (Maki, Kluger Crnich, 2010). The article states that the rates of nosocomial blood stream infections are directly dependent on their clinical surveillance. â€Å"We believe that clinical surveillance data in general overestimate the true risk of catheter-related BSI with CVCs while underestimating the actual risk of IVD-related BSI with other types of IVDs because each device in use in the hospital during the surveillance period is not routinely scrutinized† (Maki, Kluger Crnich, 2010). This theory is based on their finding that hospitals report all health care associated blood stream infections as being caused by central venous catheters if they cannot find a link to a local infection which therefore leads to an overestimation of CVC related infections. However, does this mean we disregard the possibility of a CVC related blood stream infection because it may or may not have been caused by an unknown outside source? No it doesn’t. Numerous factors affect the patients risk for infection; mainly catheter location, catheter duration and method of removal. Nurses play a huge role in the care of central venous catheters, they assist in insertion, and have â€Å"primary responsibility for all aspects of central line management† (Haller Rush, 1992). Therefore, nursing interventions have to be set in place in order to assure proper care of CVC’s. First and foremost, it is hugely important to perform a thorough assessment on all patients prior to insertion of a central line. Things such as patient age, medical history and current medical treatment can predispose a patient to infection. Children and elderly patients especially are more immunocompromised than a young or middle age adult and therefore are at higher risk. Patients with diabetes, adrenal insufficiency, cancer, autoimmune diseases, transplants, radiotherapy and poor nutritional status may be immunocompromised and are also at higher risks for infection (Haller Rush, 1992). We also need to look at why and if the patient truly needs something as invasive as a central venous catheter. Can something else be done that doesn’t predispose a patient to infection? If the patient really is a candidate for a CVC then the site of the line is incredibly important in regards to prevention of infection. Sterile technique is key with central lines, and the use of central line bundles can help reduce infection. However, the number of times a line is attempted holds higher risks. You could be as sterile as possible but repeatedly attempting to insert a line decreases the likelihood that asepsis is maintained and therefore increases patient risk for infection. It is critical that we as nurses advocate for our patients, especially with repeated catherization attempts. It is also our responsibility to ensure that sterility is maintained and it is also our responsibility to speak on behalf of our patient, when is too many tries enough? If we do not look out for our patients then who will? Once the line is in, it is our responsibility to maintain sterility during dressing changes and we need to make sure there is an occlusive dressing on the site at all times and any dressing that is wet should be changed immediately (Haller Rush, 1992) In another peer reviewed article by Torricone et al, the highest rate nosocomial infections occur in intensive care units (ICUs), â€Å"and most are associated with the presence of invasive devices such as a central line† (2010). The article states that it’s expected that 25% of the patients who have central lines are expected to attract an infection because of it. These infections worsen the patient’s current condition and can eventually prove fatal. On the financial end, central line associated blood stream infections lead to much longer hospital stays which leads to higher healthcare costs, producing a domino effect that could ultimately have been prevented. The Institute for Health Improvement estimates that â€Å"forty-eight percent of ICU patients have central venous catheters, accounting for about15 million central venous catheter days per year in ICU† (2008). Of these, 18% are deaths due to Central Line Blood Stream Infections. An article by Torricone et al. peaks of a few interventions that could ultimate reduce these infections rates. Interventions such as bundles that include â€Å"both behavioral (e. g. , maximal sterile barrier precautions, catheter placement and optimal timing of replacement, surveillance, education, improved hand hygiene technique and compliance, etc. ), and technological (e. g. , use of preferred skin antiseptics such as chlorhexidine gluconate, closed infusion containers, catheter dressing s, etc. ) practices† (Torricone et al, 2010). Another intervention includes a closed infusion container with self-sealing injection ports that reduces the risk of air and organisms from entering the infusion. According to the American Association of Critical Care Nurses (AACN), a large proportion of nosocomial infections result from â€Å"cross-contamination from the hands of healthcare workers† (2005). It is important to Always wash your hands  before and after  putting on or removing gloves, direct patient contact, inserting a peripheral catheter or assisting with CVC nsertion, palpating a catheter insertion site, changing a catheter dressing, accessing the catheter to administer a medication or flush (Hadaway, 2006). The CDC also recommends the use of alcohol-based hand rubs between patient contacts instead of just hand washing alone (AACN, 2005). Always wash your hands  before and after  putting on or removing gloves, direct patient contact, inserting a peripheral catheter or assisting with CVC insertion, palp ating a catheter insertion site, changing a catheter dressing, accessing the catheter to administer a medication or flush (Hadaway, 2006). Also, change gloves  used for other patient-care tasks before you perform any infusion or catheter care tasks. The use of the Central Line Bundle is also beneficial. The bundle focuses on hand hygiene, maximal barrier precautions, chlorhexidine skin prep, optimal catheter site selection, and daily assessment of line necessity with prompt removal of unnecessary lines (Institute for Healthcare Improvement, 2008). An article written by Suzanne M. Brungs, RN, MSN, MBA, OCN, and Marta L. Render, MD, supports the use of bundles for Central Lines in an effort to reduce infections. The bundle is composed of hand hygiene, use of chlorhexidene as a skin prep prior to insertion, a full body-drape that covers the patient from head to toe, barriers such as sterile gloves, gown, masks and caps to be worn by the inserter and avoidance of using the femoral insertion site (2005). The article reports that since the implantation of these bundles, central line associated blood stream infections were reduced by at least 50% and â€Å"compliance with using evidenced-based practices increased from 30% to nearly 95%† (Brungs Render, 2005). Florence Nightingales Environmental Theory supports the Joint Commissions patient safety goal to reduce central-line related blood stream infections. She believed that the patient is affected by the environment and that the nurse acted on the patient. By controlling the environment you could control the patient’s health. Cleanliness, among other factors, in her theory, facilitated the patients healing process. This is essentially the same thing we are doing with the use of CVC bundles. By controlling our environment and maintaining sterility during insertion, management and care of central lines, we reduce the risk of infection and promote the patients well being. Good hand hygiene prevents bacteria from being passed from one patient to another, which therefore reduces risks of infection. Another theorist that supports the Joint Commissions patient safety goal is Dorothea Orem. Her self-care model states that when the patient cannot care for his/herself, it is the nurse who in turn meets the patient’s needs by acting and doing for the patient (Current Nursing, 2010). The nurse guides, teaches, supports and provides an environment that promotes patient care and health. This is the whole premise of advocacy. When the patient cannot speak for his/herself or when they aren’t knowledgeable about a specific procedure it is our duty to make sure we assume the role of patient advocate and do for the patient and teach the patient. It is up to us that the patient received optimum care. Ultimately, patients are at risk with any intra vascular device but there are steps that we can take to minimize risks for infection. Many national efforts today are aimed to reduce the risk of blood stream infections related to central lines. I believe that infection control programs must strive to apply universal and consistent control measures and prevention tips with all types of CVC’s. There is no doubt they are here to stay but it is essential that all healthcare providers are given the tools necessary to ensure patient safety and satisfaction. There is no excuse for an infection. We must advocate and we must strive to protect our entire patient population. References American Association of Critical Nurses. (9/2005). AACN practice alert: Preventing catheter elated blood stream infections. Retrieved from http://www. aacn. org/WD/Practice/Docs/Preventing_Catheter_Related_Bloodstream_Infections_9-2005. pdf Brungs, S. M. , Render, M. L.. (2005). Using evidenced-based practice to reduce central line infections. Clinical Journal of Oncology Nursing, 10(6), 723-25. Hadaway, L. C.. (2006). Keeping central li ne infection at bay. Nursing 2006, 36(4), 58-64. Haller, L. T. , Rush, K. L.. (1992). Central line infection: a review. Journal of Clinical Nursing, 1, 61-66. Institute for Healthcare Improvement. (2008). Prevention of central line-associated bloodstream infection. Retrieved from http://www. hi. org/NR/rdonlyres/01E7F0ED-EEDE-41BA-ABB0-982405602158/0/cli. pdf Maki, D. G. , Kluger, D. M. , Crnich, C. J.. (2006). The risk of bloodstream infection in adults with different intravascular devices: A systemic review of 200 published studies. Mayo Clinic Proceedings, 81(9), 1159-71. Nursing theorists: A companion to nursing theories and models. (2010). Retrieved from http://currentnursing. com/nursing_theory/nursing_theorists. html The Joint Commission. (2009). Accreditation program: Hospital national patient safety goals. Retrieved from http://scholar360. com/cchs/media/user/1341/Joint%20Commission%202010%20NPSGs_3. pdf