Nosocomial infections = bacteremia and line infections Flashcards
indications for catheter removal in CVC associated infections
if culture from line grows: staph aureus, pseudomonas aeruginosa, fungi (candida) and mycobacteria
when should catheter related blood stream infection (CRBSI) have removal of CVC (based on clinical indications)
Clinical: severe sepsis suppurative thrombophlebitis endocarditis persistent blood infection >72 hrs after appropriate abx therapy hemodynamic instability
do all catheter related blood stream infection (CRBSI) need to have CVC pulled?
not always . If there’s no systemic signs of infection or fever or positive blood cultures it’s not necessary to replace tip, phlebitis without signs of infection, and even if catheter tip cultures bacteria that aren’t part of list “no-no” bugs ok for catheter salvage therapy.
reasons for catheters include:
management of acute urinary retention, measurement of critical ill urine output management of neurogenic bladder management of hematuria with clots during surgery to assess volume status end of life care
to avoid complications of urinary catheters these measures can be done:
using catheters only when appropriately indicated
prompt removal of catheters when no longer indicated
using alternatives for catheters (condom catheters and pure wix and diapers
most common cause of iatrogenic blood stream infection:
central line associated blood stream infections CLABSI
how to reduce incidence of CLABSI
hand hygiene prior to catheter insertion
use of catheter cart/kit that includes all necessary items for insertion
Chlorexidine for insertion site cleaning
maximal sterile precautions (gown, mask, cap, gloves, and sterile full body drape)
Removal of non essential CVC’s
what increases risk of CLABSI
risk increases with each additional stay that catheter remains in place.
how to decrease catheter related infections and catheter site care:
daily chlorhexidine bathing in ICU pts to decrease CVC related infections
routine hand washing prior and after catheter line palpation
sterile technique and chlorhexidine skin disinfection before catheter insertion
replace catheter suspected infection, purulence fever, HDS
do not use guide wire technique to replace.
catheter location makes a difference for catheter related infections such as:
high risk: lower extremity over upper extremity
higher risk femoral vs internal jugular vs subclavian
when should you replace a peripheral IV
within 24 to 48 hrs if not inserted with sterile technique
do we need to replace CVC catheters
not routinely but remove when no longer needed
PICC lines
can be used for months
catheter material can make a difference in CVC related infections
yes. antimicrobial impregnated catheters and fewer ports may reduce CVC related infections
Treatment of Staph aureus and CLABSI
> 4 weeks of antibiotics
