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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Is it possible to achieve a target of zero central line associated bloodstream infections?
Leon J Worth1, Mary-Louise McLaws
1Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. leon.worth@petermac.org
Insights
Achieving zero central venous catheter (CVC)-associated bloodstream infections (CLABSIs) is feasible for ICU patients with short CVC dwell times. However, current evidence does not support a zero-infection target for all patient groups.
Area of Science:
- Infection Control and Prevention
- Healthcare-Associated Infections
- Epidemiology
Background:
- Central venous catheter (CVC)-associated bloodstream infections (CLABSIs) lead to adverse patient outcomes and increased healthcare expenditures.
- Reduced reimbursement policies for CLABSI events are implemented in the United States, emphasizing the need for effective prevention strategies.
- The feasibility of a zero-infection target for CLABSIs remains unevaluated.
Purpose of the Study:
- To identify key factors contributing to the development of CLABSIs.
- To evaluate the current evidence supporting the attainment of a zero CLABSI infection rate.
Main Methods:
- Systematic review of existing literature on CLABSI prevention and surveillance.
- Analysis of factors influencing CLABSI rates, including patient populations, CVC dwell time, and prevention strategies.
- Evaluation of current surveillance methodologies and data reporting practices.
Main Results:
- Limitations in current surveillance methods and aggregate data reporting hinder the achievement of target CLABSI rates.
- Standard prevention practices, such as hand hygiene, are integral to care bundles.
- CVC dwell time is a critical factor for risk stratification; additional strategies may benefit patients with prolonged CVC use.
Conclusions:
- A zero CLABSI rate is a realistic target for intensive care unit (ICU) populations with CVC dwell times of 1-9 days after aseptic insertion.
- Enhanced preventive measures should be prioritized for patients with anticipated longer CVC dwell times.
- Refinement and validation of surveillance methodologies are necessary to establish target CLABSI rates for non-ICU populations.
Purpose Of Review:
Central venous catheter (CVC)-associated bloodstream infections (CLABSIs) result in poorer patient outcomes and increased healthcare costs. Reduced reimbursement for CLABSI events is now provided for hospitalized patients in the United States. Although a zero target is proposed, the feasibility has not been evaluated. The objective of this review is to identify factors contributing to CLABSI and determine whether current evidence supports attainment of a zero infection rate.
Recent Findings:
Limitations of current surveillance methods and reporting of aggregate data impact on achieving target CLABSI rates. Standard prevention practices, including physician and patient preparation (e.g. hand hygiene), are frequently incorporated into bundles of care. CVC dwell time has been identified as means of risk stratification. Additional strategies (e.g. chlorhexidine-impregnated dressings, antimicrobial-coated devices) may be better used in patients with expected long dwell times. Non-ICU populations are increasingly targeted with prevention strategies, but expected rates of infection have not been proposed.
Summary:
A zero CLABSI rate should be the target only for ICU populations having CVCs with a dwell time of 1-9 days following aseptic insertion. Additional measures should be reserved for patients with expected longer dwell time. Refinement and validation of surveillance methodology is required before target CLABSI rates can be proposed for non-ICU populations.
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