The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals
Infection Prevention and Control Advisory CommitteeNovember 19, 2008Clare Kioski, MPH, CIC
Infection Control and Hospital Epidemiology; October 2008, Vol. 29. Supplement 1
http://www.shea-online.org/about/compendium.cfm
Compendium Partners
Society for Healthcare Epidemiology of America (SHEA)
Infectious Disease Society of America (IDSA)
The Joint Commission Association for Professionals in
Infection Control and Epidemiology (APIC)
American Hospital Association
Compendium Endorsers
American Organization of Nurse Executives (AONE)
Association for Respiratory Care (AARC) Infusion Nurses Society (INS) Pediatric Infectious Disease Society (PIDS) Society for Critical Care Medicine (SCCM) Society for Hospital Medicine (SHM) Surgical Infection Society (SIS)
Compendium Supporters
AARP Academy Health Agency for Healthcare
Research and Quality (AHRQ) American Academy of
Emergency Physicians American Association of Critical
Care Nurses American College of Physicians American College of Surgeons American Medical Association Cardinal Health Centers for Disease Control and
Prevention (CDC) Council of State and Territorial
Epidemiologists (CSTE)
HCA Health System Healthcare Infection Control
Practices Advisory Committee (HICPAC)
Institute for Healthcare Improvement (IHI)
International Society for Microbial Resistance (ISMR)
National Foundation for Infectious Diseases (NFID)
National Quality Forum (NQF) Premier, Inc. Society of Infectious Diseases
Pharmacists (SIDP) Trust for America’s Health
(TMAH) United Healthcare WellPoint Health Network
Six Categories of HAIs
Two focused on Specific Organisms Methicillin Resistant Staphylococcus
aureus (MRSA) Clostridium difficile infection (CDI)
Six Categories of HAIs
Four Device-and Procedure-Associated Central Line Associated Bloodstream
Infections (CLABSI) Ventilator Associated Pneumonia (VAP) Catheter-Associated Urinary Tract Infection
(CAUTI) Surgical Site Infection (SSI)
SHEA / IDSA Compendium
Compliments CDC guidelines Includes metrics and indicators of
success Updated guidance in areas where official
guidance is pending SSI and UTI guidelines are in preparation
Format suitable for implementation in a clinical setting.
Patient Guides
Developed by the SHEA Patient Safety and Quality Improvement Committee in collaboration with the Centers for Disease Control and Prevention (CDC)
Recommendation Format
Purpose Rationale and Statements of Concern Strategies to Detect Strategies to Prevent Recommendations for Implementing
Prevention and Monitoring Strategies Performance Measures
Strategies to Detect
Surveillance Protocol and definitions Use consistent surveillance methods and
definitions to allow comparison with benchmarkdata
Refer to the National Health and Safety Network (NHSN) Manual: Patient Safety Component Protocol
Strategies to Prevent
Existing guidelines and recommendations
Infrastructure requirements Practical approaches
Recommendations for Implementing Prevention and Monitoring Strategies Basic Practices Special Approaches
If rates are still high despite implementation of basic practices
Approaches that should NOT be considered
Unresolved issues
Performance Measures
Internal Reporting Process Measures Outcome Measures
External reporting State and federal requirements External quality initiatives
Strength of Recommendation and Quality of Evidence
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Rationale and Statements of Concern
Increased length of hospital stay Increased Cost
$3,700-$29,000 per episode Risk Factors
Prolonged hospitalization before catheterization Prolonged duration of catheterization Heavy microbial colonization at insertion site Heavy microbial colonization of catheter hub
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Strategies to Detect
Use NHSN Criteria Bloodstream infection (BSI)Definition Central Line Definition Denominator Description
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Strategies to Prevent
Existing Guidelines & Recommendations Healthcare Infection Control Practices
Advisory Committee (HICPAC) Institute for Healthcare Improvement (IHI) Agency for Healthcare Research and Quality
(AHRQ) Infrastructure Requirements
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Strategies to Prevent
Practical Implementation Educate physicians, nurses, and other
healthcare personnel Develop and implement catheter insertion
checklist Establish catheter insertion kits/carts
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and monitoring
Before Insertion Educate HCW on insertion, care and maintenance
of central venous catheters At Insertion
Use checklist to ensure adherence “bundle” Hand Hygiene (even when gloving) Avoid femoral veins Use all inclusive central line carts/kits Maximal barrier precautions Use chlorhexidine-based antiseptic for skin prep
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and monitoring
After insertion Disinfect catheter hubs, needleless connectors,
and injection ports before accessing catheters with alcoholic chlorhexidine preparation or 70% alcohol
Remove non-essential catheters Assess daily during multidisciplinary rounds
Change transparent dressings and perform site care with a chlorhexidine-based antiseptic every 5-7 days; change gauze dressings every 2 days
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and
monitoring After insertion
Replace administration sets not used for blood or lipids not longer than 96 hours
Use antimicrobial ointments for hemodialysis catheter insertion sites.
Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and
monitoring Perform surveillance for CLABSI
Report data to units, physician and nursing leadership, and administration
Compare rates with national NHSN rates
Edwards JR et.al. National Healthcare Safety Network (NHSN) Report, data summary for 2006-2007, issued November 2008.. Am J Infect Control 2008; 36:609-26
Prevention of Central Line Associated Bloodstream Infections (CLABSI)- Special Approaches Lack of effective control despite
implementation of best practices. Bathe ICU patients with a chlorhexidine
preparation on a daily basis Use antiseptic- or antimicrobial-
impregnated central venous catheters for adult patients
Use antimicrobial locks for central venous catheters
Prevention of Central Line Associated Bloodstream Infections (CLABSI)Approaches NOT recommended Antimicrobial prophylaxis for short-term
or tunneled catheter insertion Replace Central venous catheters
routinely Use Positive-Pressure Needleless
connectors with mechanical valves before a thorough assessment
Updating the Compendium
SHEA/APIC/IDSA Standards and Practice Guidelines Committee will determine the need for revisions on the basis of examination of current literature at annual intervals.