Catheter related bloodstream infections guidance - Hqsc.govt.nz

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Published in December 2009 by:National Quality Improvement ProgrammeCatheter-related Bloodstream Infection ProjectC/- Auckland District Health BoardPrivate Bag 92189Victoria Street WestAuckland 1142New ZealandThis manual is also available on the Infection Prevention and Control Programme website:www.infectioncontrol.org.nzISBN: 978-0-473-16365-5 (web)DisclaimerAlthough every effort has been made to ensure that this guidance document is as accurate aspossible, the authors will not be held responsible for any action arising out of its use. District HealthBoards and other organisations or individuals involved in implementing a catheter-relatedbloodstream infection control programme should also refer directly to other documents andevidence referred to in these guidelines; and decide for themselves the most appropriate approachfor their particular circumstances.ii
Table of contentsTable of contents ............................................................................................................... iiiAcknowledgements ........................................................................................................... ivForeword ............................................................................................................................ vThe National Quality Improvement Programme ............................................................... vThe Infection Prevention and Control Programme ........................................................... vThe Catheter-related Bloodstream Infection (CRBSI) Project ......................................... viIntroduction ........................................................................................................................ 1Case for change ................................................................................................................. 3The evidence based intervention bundles .......................................................................... 4Central venous catheter insertion bundle ........................................................................ 4Optimal catheter site selection ..................................................................................... 4Hand hygiene............................................................................................................... 5Chlorhexidine skin antisepsis ....................................................................................... 5Maximal barrier precautions ......................................................................................... 6Exceptions to insertion bundle practice ........................................................................... 6Central venous catheter maintenance bundle ................................................................. 7Daily review of line necessity and prompt removal of unnecessary lines ...................... 7Dedicated access for total parenteral nutrition ............................................................. 7Access the CVC lumens aseptically ............................................................................. 8Daily review of entry site for inflammation .................................................................... 8Other issues to be considered ......................................................................................... 8Education ..................................................................................................................... 8Antimicrobial catheters ................................................................................................. 9Antimicrobial locks ....................................................................................................... 9Alcohol locks ................................................................................................................ 9Chlorhexidine impregnated dressing ...................................................................... 9Practice change /implementation ...................................................................................... 10Clinical Practice Improvement Model ............................................................................ 10The team ................................................................................................................... 10The goal ..................................................................................................................... 11The strategy ............................................................................................................. 11Measurement ................................................................................................................... 11Central line insertion bundle compliance ....................................................................... 12Central line maintenance bundle compliance ................................................................ 12CRBSI rate per 1000 central catheter-days ................................................................... 13Appendix 1: Example of insertion checklist ....................................................................... 14Appendix 2: Insertion Bundle Compliance Audit Summary ............................................... 16Appendix 3: Maintenance Bundle Compliance Audit Summary ........................................ 17Appendix 4: Example of a Daily Goals Chart .................................................................... 18Appendix 5: Example of a Maintenance Bundle Checklist ................................................ 19Appendix 6: Example of CVC trolley or kit ........................................................................ 21Appendix 7: Abbreviations ................................................................................................ 22Appendix 8: Centers for Disease Control and Prevention CRBSI Definition ..................... 23References ....................................................................................................................... 25iii
Page 1: Guidance forNew Zealand HospitalsPr
Page 6 and 7: aviation) who have achieved a high
Page 8 and 9: IntroductionIntravenous catheters a
Page 10 and 11: (NICU) Collaborative viii has also
Page 12 and 13: Whenever possible and not contraind
Page 14 and 15: possible. Strict adherence to the i
Page 16 and 17: to the infection prevention practic
Page 18 and 19: The goalThe team can set goals to h
Page 20 and 21: No. of patients with CVCs withALL f
Page 22 and 23: Central Line Insertion ChecklistPur
Page 24 and 25: Appendix 3: Maintenance Bundle Comp
Page 26 and 27: Appendix 5: Example of a Maintenanc
Page 28 and 29: Appendix 6: Example of CVC trolley
Page 30 and 31: Appendix 8: Centers for Disease Con
Page 32 and 33: References1 Graves, N., Nicolls, T.
Page 34: Published in December 2009 by:Natio

Catheter related bloodstream infections guidance - Hqsc.govt.nz

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