The 100,000 Lives Campaign: Prevent Central Line Infections

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The 100,000 Lives Campaign Prevent Central Line
Infections

• Institute for Healthcare Improvement

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Incidence and RiskEffects on Cost and Hospital
Stay

• 48 of ICU patients have central venous
  catheters,
• The case fatality rate for catheter-related
  bloodstream infections (CR- BSI) approaches 20.

• Estimated cost per bloodstream infection 3,700
  to 29,000.
• Nosocomial bloodstream infections prolong
  hospital stays by a mean of 7 days

Mermel LA. Ann Int Med. 2000132 391-402. Soufir
L et al. Infect Control Hosp Epidemiol. 1999
Jun20(6)396-401.
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Benefits of Reducing CR-BSI

• Better patient outcomes
• Reduced mortality
• Improved satisfaction
• Nursing
• Physician
• Patients and families
• Financial benefits

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The Central Line Bundle

• is a group of interventions related to
  patients with intravascular central catheters
  that, when implemented together, result in better
  outcomes than when implemented individually.
• Bundle Grouping of best practices

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Central Line Bundle Elements

• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Optimal catheter site selection, with subclavian
  vein as the preferred site for non-tunneled
  catheters in adults
• Daily review of line necessity with prompt
  removal of unnecessary lines

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But, Does It Work?

• ICUs that have implemented multifaceted
  interventions
• similar to the central-line bundle have nearly
  eliminated
• CR-BSIs.
• Berenholtz et al. Critical Care Medicine. 2004
  322014-2020.

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Outcome and Cost Impact

• Rate of CR-BSIs fell from 11.3 to 0 /1000
  catheter days.
• Prevented annually (estimated)
• 43 CR-BSIs
• 8 deaths
• Estimated savings to hospital 1,945,922

Berenholtz et al. Critical Care Medicine. 2004
322014-2020.
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Central LineBundle Explained
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Hand Hygiene

• The single most effective way to prevent the
  spread of disease

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Hand Hygiene products at UMC
Soap and Water
Alcohol based hand sanitizers
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So how are we doing?
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Hand Hygiene

• Technique
• Alcohol hand based sanitizers apply product (1
  pump of dispenser) to palm of one hand and rub
  hands together covering all surfaces of hand and
  fingers 15 to 25 sec. May be used if hands are
  not visibly soiled.
• Regular hand wash wet hands apply 3 to 5 ml of
  soap rub vigorously 15 seconds rinse, dry, and
  turn off faucet with towel.

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CDC Guidelines on Hand Hygiene

• CDC Guidelines issued
• Do not wear artificial fingernails or extenders
  when providing patient care
• Category IA- (strongly recommended for
  implementation and strongly supported by
  well-designed experimental, clinical, or
  epidemiologic studies).

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Maximum Barrier Precautions
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Maximum sterile barrier precautions during
catheter insertion

• Insertion Barrier Precautions
• Use aseptic technique including a cap, mask,
  sterile gown, sterile gloves, and a large sterile
  sheet (Category IA) Strongly recommended for
  implementation and supported by well-designed
  experimental, clinical, or epidemiologic studies
• Use a sterile sleeve to protect pulmonary artery
  catheters during insertion
  (Category IB) Strongly recommended for
  implementation and supported by some
  experimental, clinical, or epidemiologic studies
  and strong theoretical rationale

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Chlorhexidine Skin Antisepsis

• Prepare skin with antiseptic/detergent
  chlorhexidine 2 in 70 isopropyl alcohol.
• Pinch wings on the applicator to pop the ampule.
  Hold the applicator down to allow the solution to
  saturate the pad.
• Press sponge against skin, apply chlorhexidine
  solution using a back and forth friction scrub
  for at least 30 seconds. Do not wipe or blot.
• Allow antiseptic solution time to dry completely
  before puncturing the site ( 2 minutes).

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Optimal catheter site selection, with subclavian
vein as the preferred site for non-tunneled
catheters in adults
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Subclavian Approach
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Check ListPlacement of Central Venous Catheters,
including PICCs, Hemodialysis, and Pulmonary
Artery Catheters, in adult and pediatric patients

• Hand Hygiene
• Maximum Sterile Barrier Precautions
• Long sleeved sterile gown
• Sterile gloves
• A large sterile sheet
• Optimal Site Selection
• Subclavian site if non tunneled catheters in
  adults
• Disinfect clean skin with 2 chlorhexidine.
  Tincture of iodine, an iodophor or 70 alcohol
  can be used
• Allow antiseptic to air dry before catheter
  insertion.
• Maintain aseptic technique

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Daily review of line necessity with prompt
removal of unnecessary lines

• Prevent Infection
• As soon as the line is no longer needed, get it
  out

• Daily review of line necessity
• Assess the need to keep the line in on a daily
  basis

Fact Catheters and other invasive devices are
the 1 exogenous cause of hospital-acquired
infections.
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Summary

• Central line infections are common.
• Proven strategies exist to decrease CR-BSI.
• Using the Central Line Checklist, most bundle
  elements are implemented. Add the Daily Goals
  sheet to verify necessity of all lines every day.
• Thousands of lives and millions of dollars can be
  saved with reliable adherence and bundle
  execution.