2023 Licensed CLABSI Prevention

Updated 12/2023

PREVENTION

CLABSI

START

vASCULAR ACCESS

OBJECTIVES

CLABSI

By the end of this module, the learner will be able to:

• Identify key measures to preventing CLABSI
• Understand daily elements of assessment and care of the patient with a central line such as:
• CLABSI bundle
• Nasal decolonization
• Central line dressing and tubing changes
• CHG bathing

CLABSI PREVENTION: RISK FACTORS

• Site of Insertion:
• Arm or neck are preferred sites for central lines to minimize CLABSI risk, other sites (such as femoral) are at higher risk for contamination

• Number of lumens:

• More lumens = higher risk for tissue trauma, contamination

• Secondary Infection:
• Having an infection somewhere else= greater CLABSI risk

CLABSI

CLABSI PREVENTION: INSERTION

• Prevention starts at insertion:
• Staff inserting and maintaining central lines must adhere to best practices until it is removed
• Procedure:
• The bedside nurse is present for insertion and performs time out with proceduralist
• Ensure sterility is maintained during insertion and at all dressing changes
• Adherence to hand hygiene and PPE best practices is crucial

CLABSI

You are assisting in a central line insertion. What can you do to prevent CLABSI?

Pull the patient's curtain to prevent contamination

Ensure everyone has a mask with a face shield

Watch for a break in the sterile field

clabsI

Rationale: Any break in sterile field increases risk of contamination. Face shield is only needed if there is a risk of being splashed in the face, or are the proceduralist. The curtain is pulled for patient privacy.

CORRECT!

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clabsi

A risk factor for a patient getting a CLABSI includes which of the following?

Having a secondary infection elsewhere

Scrubbing the hub 5x

Labeling the dressing with date and initials

Rationale: Not adhering to best practice is one of the highest risk factors for a patient developing a CLABSI. Labeling the dressing and scrubbing the hub are CLABSI prevention measures.

CORRECT!

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NURSING ASSESSMENT

• ASK
• Does the patient's condition still warrant the need to have a central line?
• NOTIFY
• Alert the provider team if a central line removal plan should be developed (ex: if line no longer functioning)
• ASSESS
• Check for patency, blood return, date last changed, and that dressing is intact each time you access the central line, at least once per shift

CLABSI

Which of the following should be done everyday when a patient has a central line?

Change the tubing

DressingChange

Assess the need for the central line with the team

CLABSI

Rationale: The patient's risk for CLABSI increases the longer the central line is in place. Dressing changes happen every 2-7 days, PRN. Always aspirate prior to flushing to check lumen patency.

CORRECT!

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*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

CLABSI PREVENTION: NASAL DECOLONIZATION*

• What is it?
• An antiseptic swab that is used inside the nose to get rid of common bacteria that could lead to CLABSI with those patients who have a central line, given in 10 doses. We use mupirocin at VUMC.
• Who receives this in Acute Care & Stepdown:
• All patients with newly inserted central lines or midlines, all new patients admitted with a line already in place, or transfer from ICU who has not completed full course

• Who receives this in ICU Areas:
• All ICU and stepdown patients admitted or transferred to ICU areas must complete full course

CLABSI

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

CLABSI PREVENTION: NASAL DECOLONIZATION*

• How to perform Nasal Decolonization:
• Apply thin layer of mupirocin to swab
• Place HOB at 30 degrees if patient can tolerate
• Have patient blow nose/clean nostrils with tissue
• Insert swab into nostril and rotate for 30 seconds (ensuring inside tip of nose is swabbed)
• Repeat with fresh swab in other nostril.
• Notes:
• Cotton swabs from supply room can be used for application.
• Mupirocin will be dispensed as a patient specific multidose tube. After use, return this to the patient specific drawer.

CLABSI

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

CLABSI PREVENTION: NASAL DECOLONIZATION*

• Contraindications:
• Recent nasal fracture/procedure
• Presence of nasal packing
• Active CSF leak
• Active nasal hemorrhage/nosebleed
• Platelet count under 10,000
• Allergy to mupirocin or povidine-iodine

CLABSI

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

CLABSI PREVENTION: NASAL DECOLONIZATION*

• Documentation
• Flowsheets> ALL DOC> Infection/Metabolic
• Document "Done " or "Not Done" in "Intranasal Swab Application" row
• If "Not Done" is selected and Intranasal Anticeptic Contraindicated row cascades with the option to choose "yes." This is where you would document refusal
• Notes:
• Worklist tasks will appear at 10:00 and 22:00 for 5 days. You can document from these!
• Don't forget to document patient education process. If using the worklist, you will receive a task!
• With mupirocin, you will document through the MAR as you do with other medications

CLABSI

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

CLABSI PREVENTION: NASAL DECOLONIZATION*

CLABSI

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

CLABSI PREVENTION: NASAL DECOLONIZATION*

• Other considerations:
• If patient refuses, educate on purpose of nasal decolonization. if they still refuse, notify team and document refusal.

• If a dose is missed, continue with next dose until therapy complete

• If the line is discontinued, complete the course as ordered

• If patient is receiving for surgery they do not need additional
• If they have already received during current admission, they do not need to repeat
• If they are discharged before course is complete, they do not need to do at home, this is only for patients who are admitted

CLABSI

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

It is ok if a single nasal swab is missed when a patient is receiving nasal decolonization. Just continue counting with the next swab.

False

Only inthe ICU

True

clabsi - prevention basics

*Check with your specific facility/unit if you are outside of main campus VUMC to ensure this is your current process.

Rationale: If a single swab dose is missed, you resume the count with the next swab. If 2 or more are missed, you restart the count from the beginning.

CORRECT!

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CLABSI PREVENTION: CHG BATHING

• What is it?
• A skin antiseptic that helps prevent the spread of bloodstream infections and the spread of antibiotic resistent bacteria.
• Who receives this in Acute Care & Stepdown:
• All patients with a central line or midline, hemodialysis catheters, and/or accessed ports receive this daily
• Who receives this in ICU areas:
• All patients admitted or transferred to ICU areas receive this daily

CLABSI

CLABSI PREVENTION: CHG BATHING

• How To Key points:
• Apply CHG to dry skin AFTER regular bath or shower
• Use ONLY CHG compatible lotions and other products when patient is receiving CHG bathing
• Requires gentle scrubbing to remove bacteria
• Use a new cloth for each step
• Does not replace regular bath, this is in addition to

• Exclusion Criteria:
• Patients who have an allergy to CHG

CLABSI

CLABSI

Skin may feel sticky for a few minutes. Do NOT wipe off. Allow to air dry.

1. Neck, shoulders, chest
2. Both arms and hands
3. Abdomen then groin/perineum
4. Right leg and foot
5. Left leg and foot
6. Back of neck, back, then buttocks

CLABSI PREVENTION: CHG BATHING

CLABSI

• EPIC Nursing Flowsheets
• Self Care (ADL) interventions
• If patient is allergic, also document here
• Document exact time of bath

CLABSI PREVENTION: CHG BATHING

All patients with a central, midline, or hemodialysis catheter, or accessed port must receive a daily CHG bath.

Only inthe ICU

True

False

clabsi - prevention basics

Rationale: While every patient receives a daily CHG bath in the ICU, Acute Care and Stepdown patients with central, midline, hemodialysis catheters, and access ports are the only patients requiring daily CHG baths.

CORRECT!

clabsi

At what time should the CHG bath be documented?

It doesn't need to be documented

The time the bath is actually completed

1000 and 2200

CLABSI

Rationale: Any intervention or care should be documented on a patient at the time it is completed, not the time it is due.

CORRECT!

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CLABSI PREVENTION: DRESSINGS

• Assess:
• Is it clean, dry and intact?
• Is it labeled with date and initials?
• Is it secure with a StatLock?

• Change:
• CHG dressings are changed every 7 days and PRN
• Gauze dressings are changed every 2 days and PRN

CLABSI

CLABSI PREVENTION: TUBING

• Changing IV tubing on time is essential to help prevent CLABSI. Different infusions require you to change the tubing in different intervals:
• 96 hours: IV hydration and many medication tubing, transducers and pressure tubing, TPN tubing for pediatrics
• 24 hours: TPN, Lipid tubing
• 12 hours: Propofol

• 4 hours: Blood product tubing
• Label tubing with "Must Change" date when hung

CLABSI

CLABSI PREVENTION: ACCESS PORTS

• Scrub the hub
• Scrub the hub/port 5 times around and 5 times across the top and allow to dry before accessing
• Scrub hub EVEN IF swab cap in place prior to accessing
• Swab Caps
• All inactive port hubs need to have a swab cap
• Sterile End Caps
• If you have an intermittent infusion, the inactive IV tubing must have a red sterile end cap

CLABSI

clabsI

Which of the following is an important part of a dressing change?

Labeled with date and initials

Labeled with date of next dressing change

Labeled with the type of dressing applied

Rationale: Dressings should be labeled with the date the dressing was changed, and the initials of the person that changed the dressing.

CORRECT!

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How often should IV tubing infusing TPN be changed?

Every24 hours

Every72 hours

Every96 hours

Rationale: Change tubing every 96 hours for: IV Solution and Medication tubing, Transducers and pressure tubing, TPN infusion tubing for pediatrics. Change every 24 hours for intralipids.

CORRECT!

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What is proper care for unused ports on CVCs and IV tubing?

NothingJust scrub the hub before using

PlaceRed Cap

Placeswab Cap

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Rationale: The swab cap should be placed on all unused ports. The red cap is for the end of unused IV tubing. Scrubbing the hub should be done prior to any use of any port.

CORRECT!

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**Each card has suggestions on the best method for verifying each point.**

5. Verify Sterile end cap use on inactive IV tubing 6. Verify catheter secured to reduce movement or tension 7. Verify IV tubing is dated/timed and labeled 8. Verify RN scrubs the hub/ port 5x around and 5x over the top before accessing

1. Verify daily discussion of line need and functionality 2. Verify decolonization 3. Verify sterile dressing change 4. Verify swab cap use on inactive ports

CLABSI BUNDLE

clabsi

CLABSI K CARD

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When auditing, if something is missing, the card is RED. Even if the nurse fixes the issue.

• Red K-Card
• One or more points was noted to be missing on the date observed

• Green K-Card
• Each point has been completed correctly on the date observed

K Card - Red vs Green

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A special thanks to the following contributers:

• Pam Bull, MSN, RN
• Original creator of this module
• Nursing Education Specialist
• Mary DeVault, MSN, RN, CIC
• Director, Infection Prevention
• Kathie Wilkerson, RN, CIC
• Infection Preventionist

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