CLABSI prevention: Audit for line necessity in a surgical intensive care unit

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Intravenous literature: Rotz, S. and Sopirala, M.M. (2012) Assessment beyond central line bundle: Audits for line necessity in infected central lines in a surgical intensive care unit. AJIC: American Journal of Infection Control. 40(1), p.88-89.

Extract:

“Central line-associated bloodstream infection (CLABSI) is a major health care burden in the intensive care unit (ICU) setting. Many risk factors associated with central lines have been studied with mixed results. Although it has long been accepted that increased duration of a central line leads to higher infection rates, little attention beyond central line bundle is paid to the factors contributing to CLABSI development. Recently, more attention has focused on reminding staff to remove lines that are not medically necessary using a daily goals checklist. Audits of line necessity with feedback to staff may have a desirable impact on staff behavior but are not routinely performed. We performed a retrospective audit of patients with CLABSI in a surgical ICU at a large academic teaching center to assess the burden of infected lines that were left in longer than medically necessary. To determine medical necessity, we established criteria for conditions requiring a central line as follows: irritant and vesicant medication use, total parenteral nutrition administration, dialysis, and hemodynamic instability (defined as use of a vasopressor or inotrope, mean arterial pressure < 60 or heart rate > 100). If no documented indication could be found in the paper or electronic medical record for greater than 48 hours, it was assumed that the line was unnecessary.”

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