- CRBSI
Link:www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
- Catheter colonisation
- 'Significant growth of a micoorganism in a quantatative or semiquantatative culture of the catheter tip, subQ catheter segment or catheter hub'
- Exit-site infection
- 'Exudate at catheter exit site yeilding a microorganism but no bloodstream infection'
- Mechanisms
- Migration of skin organisms from insertion site
- Direct contamination by hands or contaminated devices
- Haematogenous spread from other focus of infection
- Infusate contamination
- Factors affecting CRBSI
- Host
- Malignancy
- Immunodeficiency
- Malnutrition
- Severe sepsis
- MOD
- Diabetes
- Materials
- Coating
- Antibiotic impregnated
- Surface
- Insertion/handling
- Site
- Fixation
- Dressings
- Injection ports
- Injectate/infusions
- Prevention
- Education, training, adequate staffing
- Selection of appropriate site
- Appropriate duration
- Hand hygeine and aseptic technique
- Skin prep
- 2% chlorhexidine in alcohol
- Use of USS
- Catheter securement
- Replacement of administration sets
- Dedicated line for TPN
- Replacement of lines
- Antimicrobial catheter lock/flush
- CRBSI diagnosis
- Intravascular device present
- 1 positive peripheral blood culture result
- Clinical signs of infection and with no other source + one of the following
- +ve semiquantatative (15 cfu/catheter segment) or quantatative (102cfu/segment) catheter culture
- Same organism from catheter segment and peripheral culture
- Simultaneous quantitative cultures with ratio of 5:1 (CVC vs Peripheral)
- Differential time to +ve (+ve CVC blood culture is obtained >2hrs before peripheral blood culture)
- CEACCP
Link:ceaccp.oxfordjournals.org/content/5/2/49.full.pdf