Document posted here: www.zeroinfections.orgOverview: This toolkit was designed for IPs (Infection Prevention professionals) and other clinicians as a resource/reference to support efforts to amplify/enhance infection prevention and control bundles. In the absence of sustained zero preventable infections of any type, and in the absence of risk to patients, products and practices supported by less than category 1 level evidence (i.e. “Plus Measures”) are often employed to amplify/enhance IP bundles. The “Plus Measures” contained within this toolkit are most commonly supported by what CDC considers category II level evidence (see page 3 for evidence categories). Within this toolkit evidence summaries are provided for each plus measure, in order to reduce the time required for literature searching by IPs, and are updated every two years. These “Plus Measures” including products, have been identified by the author during review of peer reviewed journals, attendance of professional conferences, continuing education courses, networking with clinical experts and industry partners. Consequently, the set of plus measures (including products), represented in this document is not all inclusive or exhaustive. I welcome any suggested additions from colleagues and industry partners ([email protected]).
This document was developed by Sue Barnes. Please feel free to use and reproduce this document in the spirit of patient safety, and please retain this note for appropriate recognition.
2018 Beyond Bundles, HAI Prevention Plus Measures Toolkit - CRBSI Chapter Page 1 of 9
CDC Evidence Categories (https://www.cdc.gov/violenceprevention/pdf/understanding_evidence-a.pdf): Category IA. Strongly recommended for implementation and strongly supported by well-designed
experimental, clinical, or epidemiologic studies. Category IB. Strongly recommended for implementation and supported by some experimental,
clinical, or epidemiologic studies and a strong theoretical rationale; or an accepted practice (e.g., aseptic technique) supported by limited evidence.
Category IC. Required by state or federal regulations, rules, or standards. Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic
studies or a theoretical rationale. Unresolved issue. Represents an unresolved issue for which evidence is insufficient or no consensus
regarding efficacy exists.
https://ebbp.org/training/searchforevidence
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Catheter Related Bloodstream Infection (CRBSI) Prevention - AdultThe following category level 1 prevention measures are supported by CDC and/or SHEA guidelines:
1. Apply chlorhexidine (CHG) impregnated insertion site dressing2. Ensure appropriate nurse-to-patient ratio and limit the use of float nurses in ICUs 3. Ensure optimal catheter site selection, preferably subclavian, avoid femoral site4. Hand hygiene5. Perform surveillance for CRBSI in ICU and non-ICU settings6. Provide daily CHG bathing for patients with central venous catheter (CVC)7. Provide education and knowledge assessment for staff inserting catheters8. Use a CVC with the minimum number of ports or lumens needed9. Use aseptic technique and maximum barrier precautions for catheter insertion10. Use skin prep containing alcohol and CHG prior to insertion11. Use ultrasound guidance for insertion of CVC
If zero preventable infections have not been achieved and/or sustained, consideration might be given to adding one or more of the following “PLUS” prevention measures to your CRBSI
prevention bundle:
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Plus Measures References
Product order info Tools
1. Antiseptic (e.g. CHG, silver) impregnated insertion site dressing: Apply at time of insertion
7. Lock - antimicrobial – including citrate, antibiotic, other – for patients in hemodialysis, on long term parenteral nutrition, in pediatric oncology, other
N/A N/A
8. Midline catheters in place of central lines (consider)
