CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION.

LCBI = LABORATORY CONFIRMED PRIMARY BLOOD STREAM INFECTION.

NO.

A PT THAT HAD A CENTRAL LINE IN PLACE AT THE TIME OF OR W/IN THE 48 HR PERIOD BEFORE THE DEVELOPMENT OF THE BSI.

INTRAVASCULAR CATHETER

AT OR CLOSE TO MAJOR VESSELS

INFUSION, W/DRAW BLOOD,

HEMODYNAMIC MONITORING

GREAT VESSELS

(11 OF THEM!)

AORTA; PULMONARY ARTERY; SUPERIOR/INFERIOR VENA CAVAE; SUBCLAVIAN/FEMORAL VEINS;

COMMON/EXTERNAL ILIAC VEINS;

INTERNAL JUGULAR VEINS; BRACHIOCEPHALIC VEIN

TEMPORARY VS. PERMANENT

CENTRAL LINES

TEMP = NON-TUNNELED

PERM = TUNNELED OR IMPLANTABLE

IS AN INTRODUCER IS CONSIDERED AN

______________________

CATHETER.

IN NEONATES,

WHAT TYPES OF LINES ARE

CONSIDERED CENTRAL LINES?

UMBILICAL ARTERY AND VENOUS

CATHETERS

TRUE OR FALSE:

THE LOCATION OF THE INSERTION SITE

AND

THE TYPE OF DEVICE ARE VASC CATHS

THE TRANSFER RULE:

IF THE BSI DEVELOPS IN A PATIENT WITHIN ____ HOURS

OF TRANSFER,

INDICATE THE __________ LOCATION ON THE INFECTION REPORT

48 HOURS

TRANSFERRING LOCATION

CLABSI DEVELOPS WITHIN

48 HOURS OF TRANSFER

TO A SNF:

REPORT TO ___

___ ADD'L CENTRAL LINE DAYS ARE RECORDED

NHSN

NO ADD'L CENTRAL LINE DAYS

3 CRITERIA THAT CAN BE APPLIED

FOR

LCBIS

CRITERIA 1 & 2:  AGE RANGE

CRITERIA 3:  AGE RANGE

CRITERIA 1 & 2:  ANY AGE

CRITERIA 3:  < OR = 1 YR OF AGE

LCBI

CRITERION #1:

PATHOGEN CULTURED FROM ONE OR MORE BLOOD CX; AND,

ORGANISMS IS/IS NOT R/T AN INFECTION AT ANOTHER SITE

ONE OR MORE BLOOD CX BOTTLES POS.

AND

IS NOT R/T AN INFECTION

AT ANOTHER SITE

EXAMPLE OF CRITERION #1:

PT W/ PICC INSERTION

JUNE 1

ON JUNE 5 W/ CONFUSION, CHILLS.

WHAT MUST GROW POSITIVE

BLOOD CULTURES

POSITIVE, AND NOT RELATED TO AN INFECTION AT ANOTHER SITE

AT LEAST ONE BOTTLE FROM A BLOOD DRAW IS REPORTED AS A

POSITIVE BLOOD CULTURE

WHAT ARE NOT CONSIDERED

"RECOGNIZED PATHOGENS"?

COMMON COMMENSALS

(NORMAL FLORA)

GIVE EXAMPLES OF

"RECOGNIZED" PATHOGENS

1. STAPH AUREUS
2. ENTEROCOCCUS SPP.
3. E. COLI
4. PSEUDOMONAS SPP.
5. KLEBSIELLA SPP.
6. CANDIDA SPP., ETC.

LCBI (LAB CONFIRMED BS INFECTION)

CRITERION #2

1 - PT W/ S/SX INFECTION

2 - NOT R/T INFECT. AT ANOTHER SITE, AND,

3 - COMMON ___ CX FROM __ OR MORE BCX ON SEP. OCCAS.

GIVE EXAMPLES

OF

COMMON COMMENSALS

(HINTS:  DIP ...; BAC...; PROP...; COAG-...; VIRID...; AEROC...; ETC.)

DIPTHEROIDS (CORYNEBACTERIUM SPP., NOT C. DIPTHERIAE)

BACILLUS SPP. (NOT B. ANTHRACIS)

PROPIONIBACTERIUM SPP;

COAG-NEG. STAPH (INCL. S. EPIDERM.)

VIRIDANS GRP STREPTOCOCCI

THE PHRASE "TWO OR MORE BLOOD CULTURES DRAWN ON SEPARATE OCCASIONS" MEANS:

1-bld frm at least __ bld draws

were collected w/in ___days of ea other

2-at least __ bottle frm ea bld draw

reported as hav'g grown the same

______ skin ____________.

1-two blood draws

collected w/in two days of ea other

2-at least one bottle frm ea draw

reported as hav'g grown the same

common skin contaminant

(ie, commensal)

BLOOD DRAWS FOR BLOOD CULTURES

 ON MONDAY AND THURSDAY

ARE OKAY TO MEET CRITERIA

2 AND 3

FOR CLABSI

BLOOD DRAWS FOR BLOOD CX

ON MONDAY AND TUESDAY

OR MONDAY AND WEDNESDAY

ARE ACCEPTABLE

TO MEET CRITERIA 2 AND 3

FOR CLABSI

CLABSI CRITERIA 2 AND 3:

PEDIATRIC BLOOD CX BOTTLES

ONLY ONE BOTTLE MAY BE INNOCULATED PER DRAW,

THEREFORE, TO MEET THIS CRITERION ...

EXAMPLE OF NEONATAL CLABSI

PER CRITERION 3

(T OR F):

BLD CX POS ON TUES AND SAT

FALSE

THE TIME BTW THESE CX

EXCEEDS THE 2 DAY PERIOD

FOR BLOOD DRAWS

EXAMPLE OF CRITERION 2

FOR CLABSI

(T OR F):

ADULT W/ BLD DRAW AT

0800 AND 0815, SAME DAY.

ONE BOTTLE FROM EA. SET IS POS.

FOR COAG-NEG STAPH.

TRUE.

TWO BOTTLES.

LESS THAN 2 DAYS APART.

COMMON COMMENSAL.

LABORATORY CONFIRMED BLD INFECT.

CRITERION #2:

PT W/ TEMP 102.6

DAY 3 OF ADM

BCX DRAWN 2 HRS APART

BOTH GREW COAG-NEG STAPH

WHAT CONDITION MISSING?

PT WOULD HAVE HAD TO HAVE HAD

NO SYMPTOMS NOR

LABORATORY EVIDENCE

OF INFECTION

ON ADMISSION

LCBI CRITERION #2?:

PT ADM FOR MI

CENTRAL LINE PLACED DAY 1 ADM

T 102 DAY 4 ADM

ONE BCX POS. FOR STAPH EPI

NO.

PT DOES NOT MEET CRITERIA.

IF PT HAS ANOTHER BCX POS

FOR STAPH EPI, THEN PT

MEETS CRITERIA

FOR LCBI#2.

LCBI#3: NEONATES/INFANTS:

REQUIREMENTS INCLUDE

1-LESS THAN/EQUAL TO 1 YR OF AGE

2-S/SX INFECTION (T; APNEA; BRADY)

3-S/SX NOT RELATED TO INFECT AT ANOTHER SITE

4-?

COMMON COMMENSAL

IS CX FROM 2 OR MORE BLD CX

DRAWN ON

SEPARATE OCCASIONS

CAN LCBI CRITERIA

FOR #1 AND #2

BE USED FOR INFANTS AND CHILDREN?

BABY BORN W/OUT

S/SX OF INFECTION

DAY 2 BABY FUSSY, IRRITABLE

BCX POS PSEUDOMONAS AERUGINOSA

WHICH CRITERION IS MET?

DETERMINING "SAMENESS"

OF 2 ORGANISMS:

BCX REPORTS GENUS AND SPECIES

(S. EPIDERMIDIS)

ANOTHER BCX REPORTS GENUS

(COAG NEG STAPH)

ASSUME THE ORGANISMS ARE THE SAME.

REPORT THE MORE SPECIFIC ORGANISM IN NHSN.

THE FOLLOWING ARE THE RESULTS FROM TWO BLOOD DRAWS:

*COAG NEG STAPH

*STAPH EPIDERMIDIS

WHICH WOULD YOU REPORT

IN NHSN

DRAWING BLOOD CULTURES

SHOULD BE DRAWN FROM ...

A VASCULAR CATHETER?

TWO TO FOUR SEPARATE SITES,

NOT THRU A VASCULAR CATHETER

True or False:

there is ONE definition for BSI

when monitoring

CLABSI

Fill in the blanks.

Laboratory confirmed blood stream infection (LCBI) is defined as (all patients):

1.  recognized _______

2.  skin __________; >/= __ BC, drawn on separate occasions; positive for the same organism; __ clinical sx

3.  infant/neonate:  >/= __ BC, drawn on separate occasions; positive for the same organism; __ clinical sx

1.  recognized pathogen

2.  skin organisms; 2 BCs; positive clinical sx

3.  2 BCs; positive clinical sx

inpatient area

housed overnight

first s/sx of infection

or

date the first positive blood cx was drawn

ICU patient

central line in

48 hours prior to the event

For a Specialy Care Area pt, you note whether pt had  __ or more

permanent/temporary

______ lines in place

one or more

permanent/temporary

central lines

(RISK ASSESSMENT)

NICU patients

birthweight in grams

Does it change with age, as pt gains weight?

No. 

It is the wt in grms at birth.

Signs and symptoms of infection:

Match

any patient       fever; decr temp; apnea;

decreased T

< 1 year of age     fever; chills; hypotension

infants:

fever; hypothermia; apnea; bradycardia

any pt:

fever; chills; hypotension

BSI contributed to death:

Circle yes if

the BSI directly caused death

OR

_________________

directly caused the death

or

exacerbated an existing condition

which then led to death

For CLABSI events, the Pathogen field

will autofill as

___.

Yes. 

Specific info about the pathogen are entered on the back of the CLABSI

form.

Pathogen and antibiotic

information are organized by

* gm ___/____ organisms

* f______ organisms

* o_____ organisms

gm neg/gm pos organisms

fungal organisms

other organisms

Up to _____ organisms can be recorded for each BSI.

Each pathogen is listed in _____ of __________.

three organisms per BSI

organisms listed in order of importance

S = susceptible

I = ____________

R = resistant

NS = _______________

S-DD = susceptible/dose dependent

N = __________

I = indeterminate

NS = non-susceptible

N = not tested

List the pathogen under "Other".

Record the entire antibiogram as reported by micro.

Collecting Denominators for CLABSI:

ICU/Other locations:

# ________ on the unit

# patients on the unit w/ one or more __

ICU/Other locations

denominator date

# patients on the unit/

# pts on the unit w/ 1 or more centr lines

AT THE SAME TIME EACH DAY

Collecting denominator data for CLABSI:

SCA locations:

# ____ on the unit

# pts on the unit w/ 1 or more ___

# pts on the unit w/ 1 or more ___ ___

AT THE SAME TIME EACH DAY

SCA locations - denominator data:

# pts on the unit

# pts on the unit w/ perm. centrl lines

# pts on the unit w/ temp. centrl lines

Note:  if pt has both perm/temp CL, count the day only as a temp. CL day

NICU denominator data

CLABSI:

# pts in ea ______ category on the unit

# pts in ea _____________category on the unit with one or more ____

NICU denominator data/CLABSI:

birthweight category

each birthweight category, has a central line (one or more)

CLABSI rate =

# _______ identified

_________________________

# _________ ______ days

X 1000

CLABSI rate =

# CLABSIs identified

_________________________

# central line days

X 1000

CLABSIs are stratified by:

* ICU or _____ location

*________ Care Area (___)

- temporary/permanent line

* NICU

- ___________category

ICU or other care area

specialty care area SCA

NICU:  birthweight category

CLABSI

SIR = _______ ________ ratio

SIR = (O) ________ HAIs

________________________

(E) ________ HAIs

SIR = standardized infection ratios

observed HAIs

_______________

expected HAIs

The CLABSI SIR allows you to

* summarize your data for ______

locations, or, for

________ locations.

single locations

or multiple locations

adjusting for differences in the incidence of infection among the location types

THE CLABSI SIR (standardized infection ratio) will be calculated only if the number of expected HAIs (numExp) is

______________.

CLABSI

Device Utilization (DU) Ratio

Central Line DU Ratio =

#_______ days

____________________

# ________ days

DU ratio for central lines:

# central line days

______________________

# patient days

(no multiplier for the DU ratio)

Using CLABSI data to protect patients:

* compare your CLABSI & DU ratio data to a_________, ____-adjusted NHSN rates.

compare your clabsi and du ratio data to that of nhsn's

which is aggregated and risk-adjusted

You can compare your CLABSI data to itself over time.

This will identify t_____,

and "d___ ____" to determine

the cause.

trends

drill down

determine cause