presented by Kathleen Vollman
Central line associated blood stream infections are serious but preventable infections when evidence-based guidelines for central line insertion and maintenance are properly prioritized and implemented. If not prevented, CLABSIs result in increased length of hospital stay, increased cost and increased patient morbidity and mortality. This session will discuss key care strategies that include but go beyond the traditional bundles of care to reduce or eliminate CLABSIs. Barriers to implementation of the evidence are discussed, and frontline caregiver solutions are detailed to help facilitate ease of adoption. This course content is applicable to nurses and other health care professionals who work with patients in acute care, rehabilitation, and long-term care settings.
Kathleen Vollman is a Critical Care Clinical Nurse Specialist, Educator, and Consultant. She has published and lectured nationally and internationally on a variety of topics, including pulmonary care, critical care, prevention of health-care-acquired injuries, work culture, and sepsis recognition and management. From 1989 to 2003, she functioned in the role of Clinical Nurse Specialist for the Medical ICUs at Henry Ford Hospital in Detroit Michigan. Currently her company, ADVANCING NURSING LLC, is focused on creating empowered work environments for nurses through the acquisition of greater skills and knowledge. Ms. Vollman is a subject matter expert for prevention of CAUTI, CLABSI, and HAPI as well as sepsis recognition/management and the culture of safety for HRET and the Michigan Hospital Association. In 2004, Kathleen was inducted into the College of Critical Care Medicine; in 2009, she was inducted into the American Academy of Nurses. In 2012, Ms. Vollman was appointed to serve as an honorary ambassador to the World Federation of Critical Care Nurses.
An estimated 30,100 CLABSIs occur in U.S. intensive care units each year with up to 250,000 occurring across care settings. Patient mortality rates associated with CLABSI range from 12 to 25 percent, and the cost ranges from $3,700 to $36,000 per episode. During this session a review of the magnitude of the problem, the risk factors for development, as well as how CLABSI’s fit into the current reimbursement structure, are outlined.
The insertion bundle is discussed and includes recommendations for aseptic technique, location of the line placement, and cleansing of the site. The bundle, when implemented successfully, significantly reduces infections. The addition of a checklist to the procedure results in patients being more likely to receive the appropriate care each time the procedure is performed.
The maintenance bundle is outlined, which includes type of dressing, dressing change frequency and care, accessing the port, and intravenous line changes. When practiced together in a robust safety culture, the bundle can significantly reduce or eliminate CLABSIs.
The last national published CLABSI prevention guidelines from the CDC occurred in 2011, and the infectious disease and hospital epidemiologist as well as the infection preventionist groups latest updates, occurred in 2014. The creation of new evidence is evolving at a rapid pace, and this chapter will outline all the latest innovations that go beyond the guidelines.