Safety is in the details
Safety in the ICU

CDC Guidelines for catheter related infection prevention in ICU

December 03, 2017

 

The burden of infection control is even greater in critically ill patients, as they are naturally weakened by their state of health. ICU teams are therefore faced with the double challenge of administrating the required (and sometimes complex) procedures and routinely combating the risk for infection. The Center for Disease Control (CDC) provides Guidelines for the Prevention of Intravascular Catheter-Related Infections [1].


The Healthcare Infection Control Practices Advisory Committee (HICPAC) operates in addition to resources from CDC guidelines, especially in the prevention of intravascular catheter related infections [2].


Regularly checking for updates and / or changes  to guidelines provided by the CDC and HICPAC aids in maintaining compliance, allows for accumulating knowledge and information about recent advancements in technologies, as well as continuing development of processes and equipment that provide for the optimal safety and well-being of patients.


Infection Control Responsibility of ICU Staff


It is estimated that roughly 90% of catheter- related bloodstream infections – which are defined as BSIs - occur with central venous catheters [2]. Even more alarming is the fact that hundreds (and even potentially thousands) of patients die every year due to such infections. Nosocomial bloodstream infections extend hospital stays by approximately seven days at the outlay of $4,000 and up to $30,000 in treatment costs [2].


This is why familiarity of current CDC guidelines regarding standards for infection control in environments such as the ICU and OR is essential in providing high quality care for patients.


According to the recommendations, replacement of peripheral venous catheters within 72 to 96 hours is important in order to reduce risk of infection [1]. Replacement of administration sets no more frequently than 72 hours is deemed appropriate as well as cost-effective by the CDC. 

 

A number of standards in recent guidelines proposed by the CDC, suggest to cap stopcocks when they're not in use and using closed catheter access systems to decrease the potential of catheter-related bloodstream infections (CSBRIs) [1].


In some situations, the "piggyback" method is used as an alternative to stopcocks, but this method continues to pose contamination risks. ('piggybacking' implies secondary IV medical infusions used for delivery of one or intermittent doses over time.) The CDC notes that "modified" piggyback systems can prevent contamination [1].
Additional recommendations by the CDC and HICPAC include minimizing contamination risk of needleless intravascular devices by wiping access ports with an appropriate antiseptic as well as changing needleless components as often as changing out the administration set [1].


Awareness and Education is Key


According to the Institute for Safe Medication Practices (ISMP), risk management as well as challenges to improvement of the quality of care are continually challenged by failure to follow standardized infection control recommendations in regard to IV injections, preparations, and administration.


Continuing education regarding the dangers of colonization in catheter hubs and lumens (which contribute to up to 50% of catheter related infections [3]) and staying up-to-date with the latest advancements, protocols, and safety guidelines for optimal patient care is therefore essential.


Luer-Activated Devices (LAD) Help Control Infection, while Increasing ROI.


Fewer infections may be facilitated by adhering to aseptic techniques, newer designs and variations in needleless connectors. Staff must continually focus on decreasing intravascular catheter-related infections by following disinfection process protocols: using luer-activated devices with disinfection sponges; adopting single-use solutions on unused needleless connectors on catheters following placement of catheter or in between catheter changes; disinfecting ports reduces risk of contamination of needleless connectors as well as male luer devices [4].


Attention to detail when it comes to poor flushing, as well as minimizing manipulations and/or access to pressure monitoring systems is also important. Continued advancement in technological development of devices that reduce negative pressure and neutral IV displacement connectors are helpful.


According to the CDC, luer-activated devices (LAD) can be beneficial in eliminating negative pressure, thus reducing the risk for fluid outflow in connectors. Second generation systems (needleless) have attempted to reduce this issue by creating either positive or neutral fluid displacement environments. Neutral displacement IV connectors were implemented in 2011, designed to reduce the risk for catheter-related bloodstream infections. [5]


Using unique continuous flushing LAD stopcocks, such as Elcam’s MarvelousTM  allows staff to improve infection control and save time while creating considerable cost savings. The MarvelousTM continuous-flushing feature provides greater protection against blood clotting and bacterial colonization. The injection site remains needle free and closed - consistent with the CDC recommendations. In addition to reducing the risk for fluid outflow from the connectors, with MarvelousTM the fluid flow around the handle creates a unique “circumferential channel” that reaches the entire internal volume of the valve, assuring minimal residual volume.


Calculate your unit's ROI


Elcam is happy to present a web based ROI calculation tool. We invite you to calculate annual savings per department and per bed depending on:

  • Daily access
  • Number of stopcocks per patient and number of LADs used per stopcock
  • Amount of caps and syringes used per access for every stopcock

You will be surprised how much you can save in the long run by using MarvelousTM continuous flushing LAD stopcocks.


The human factor


It is important for ICU staff to acknowledge and remember that even with advancements in technology, needleless systems, and even though luer-activated devices, stopcocks and luer-activated valves may reduce the risk of infection, their use does not guarantee absolute protection against infection or contamination.


Human attention to detail, adherence to infection control guidelines and protocols, and common sense do prevail.


Resources:
1. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm
2. www.safecarecampaign.org/crbsi.html
3. https://www.hindawi.com/journals/nrp/2015/796762/
4. https://www.Beckers Hospital review.com/infection-control-products-to-know-list.html 
5. www.sciencedirect.com/science/article/pii/S1552885512001821

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