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CR-BSIs
Preventing Catheter-Related Bloodstream Infections
Hadaway (2006) sought to provide practice guidance to nurses for catheter-related bloodstream infections (CR-BSI). The points of emphasis included short peripheral catheters, but the main focus was infections associated with central venous catheters (CVC) because these occur more often and result in more severe adverse outcomes. To support these practice recommendations, Hadaway relied on CVC best practice guidelines published by the Institute for Healthcare Improvement (IHI). The information provided is designed to assist nurses to implement best practices in the area of CR-BSI. In addition, infection rate statistics and recommendations from the Centers for Disease Control and Prevention (CDC) were presented to show why this is important.
Hadaway (2006) discusses the five IHI guidelines for reducing the incidence of CR-BSIs. This is the best practice for reducing CR-BSIs and this is why. The argument is the best practice is improving hand hygiene, barrier precautions, antiseptic use, insertion site selection, and catheter insertion and removal techniques.
This author is writing to educate nurses on how to keep their hands from becoming contaminated. This is a big problem because it is easy for nurses to contaminate their hands as they care for patients and transition from one procedure to another (Hadaway, 2006). For this reason, the IHI recommends that infusion procedures be performed...
Alcohol-based hand cleaners are appropriate for most routine tasks, but if the hands have been visibly contaminated with bodily fluids then a good scrubbing with antimicrobial soap is indicated. Hand care is also important, because damaged skin can more easily harbor microbes. The use of emollients is recommended to promote a healthy skin barrier. Gloves should be changed and hands decontaminated before a catheter is inserted or removed, or when administering an infusion. Fingernails are important because long nails, false nails, or fingernail polish can harbor dangerous microbes. Nurses who place peripherally inserted central catheters (PICCs) or work with CVCs in an ICU should have short, natural nails only.
Maximum barrier protections are recommended for the insertion of CVCs, including those inserted peripherally (Hadaway, 2006). Sterile gown, gloves, face mask, and cap should be worn. In addition, the patient should be completely covered during the procedure except for the insertion location. The recommended antiseptic is 2 or 3.15% chlorhexidine gluconate in 70% isopropyl alcohol because the incidence of CR-BSIs and skin problems are reduced compared to other common antiseptics. With respect to insertion site choice, the IHI recommends subclavian over jugular or femoral due to neck movement and hair growth. Hadaway (2006), however, notes that studies investigating insertion site choice were published over 20 years ago with…
References
Hadaway, L.C. (2006). Best-practice interventions: Keeping central line infection at bay. Nursing, 36(4), 58-63.
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