Catheter related bloodstream infections guidance - Hqsc.govt.nz

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