Preventing central venous catheter related-bloodstream infections

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Central venous catheters (CVCs) are being used increasingly in inpatient and outpatient settings to provide long-term venous access. CVCs disrupt skin integrity making infection possible. Infection may spread to the bloodstream and hemodynamic changes and organ dysfunction (severe sepsis) may ensue, possibly leading to death.

This intervention aims to prevent CVC-related bloodstream infections by implementing a set of interventions known as the ‘CVC bundle’. The power of the ‘bundle’ brings together those scientifically grounded concepts that are both necessary and sufficient to improve the clinical outcome of interest. The focus of measurement is the completion of the entire bundle as a single intervention, rather than completion of its individual components.

Toolkit

Preventing central venous catheter related-bloodstreams infections toolkit (549kb, pdf)

Tools

CVC audit summary (82kb, pdf)

CVC audit tool (79kb, pdf)

FAQs

Safer Systems Saving Lives FAQs - February 2006 (327kb, pdf)

The toolkit suggests selecting ‘one location for investigation’. What happens when the patient leaves the unit?

This question may relate to both the compliance and the outcome measures.

For the compliance measure; consider the care the patient received while present in the unit. That is, what level of compliance was achieved prior to the patient leaving? Where the unit has complied with every aspect of the care possible to the time of the patient leaving, and documentation reflects this, mark the case as compliant with the care bundle.

For the outcome measure; if the number of patients with CVCs moving to other units represents a significant proportion of the ‘population’, and adversely affecting sample size, it may be necessary to establish a means of tracking patients. Where the number is not significant it may be simply a matter of excluding them from the sample.

What is the appropriate action when a CVC-BSI is identified? Should all lines be removed?

The Guidelines for the Prevention of Intravascular Catheter-Related Infections recommend that catheters not be removed on the basis of fever alone, and removal of lines when infection is evidenced elsewhere is a matter of clinical judgement.

I understand the maximum sample number is 20 patients. I am unsure if the data is to be collected and entered for the entire month, or is to be a ‘day’ sample, as it states on page 15 of the toolkit? Do we audit only those patients in our ICU with CVCs on that day?

The confusion may arise from the equation on page 15 of the toolkit that expresses the denominator as "Number of patient (sic) with CVCs on the day of the sample". If auditing on one day gives an adequate sample (that is, 20 patients) then a single day may be enough. If it is necessary to audit on a number of days to get a satisfactory sample, then data may be collected across the month.

The denominator could be expressed as "Number of patients with CVCs on the day(s) of the sample".

References

• Horvath, R and Collignon, P, 2003, ‘Controlling intravascular catheter infections’, Australian Prescriber, Volume 26, Number 2, pp 41-43. (Reprinted with permission from Australian Prescriber)
  
  Controlling intravascular catheter infections (73kb, pdf)

• VICNISS Hospital Acquired Infection Project, Year 3 report – June 2005
  
  VICNISS Hospital Acquired Infection Project (External link)
  http://www.vicniss.org.au/Resources/VICNISSAnnualReport0806.pdf

• O'Grady, NP, Alexander, M, Dellinger, EP et al., 2002, ‘Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention’, MMWR Recommendations and Reports, Volume 51, RR-10, pp 1-29.
  
  Guidelines for the prevention of intravascular catheter-related infections (364kb, pdf)
  

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