Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
Healthcare Consideration/Evidence Based Practice A study by Buetti et al. was designed to review literature, guidelines, and practical recommendations for acute-care hospitals for central line–associated bloodstream infection (CLABSI) prevention efforts. This document is sponsored by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with contributions from a number of organizations with content expertise. Recommendations are categorized as essential practices that should be adopted by all acute-care hospitals. Here is a summary of findings found to have a high quality of evidence: • The use of chlorhexidine-containing dressings is considered an essential practice; bathe ICU patients >2 months of age with a chlorhexidine preparation on a daily basis • Use an alcoholic chlorhexidine antiseptic for skin preparation • Ensure appropriate nurse-to-patient ratio and limit use of float nurses in the ICU • Routine replacement of administration sets not used for blood, blood products, or lipid formulations can be performed at intervals up to seven days • Perform surveillance for CLABSI in ICU and non-ICU settings • Use antimicrobial lock therapy for long-term CVC • Use recombinant tissue plasminogen activating factor (rt-PA) once weekly after hemodialysis in patients undergoing hemodialysis through a CVC • Use antimicrobial ointments for hemodialysis catheter insertion site From: [20]
Central Line–Associated Bloodstream Infections CLABSI is defined as a pathogen from a single blood culture for an organism not commonly present on the skin in a patient who had a central line at the time of infection or within 48 hours before the development of infection [19]. Additional information follows. The infection cannot be related to any other infection the patient might have and must not have been present or incu- bating when the patient was admitted to the facility. Cath- eter-related bloodstream infection (CRBSI) is the preferred term used by the Infectious Disease Society of America (ISDA). Prevention guidelines during maintenance: • Disinfect the catheter hubs, injection ports, and connections before accessing the line • Replace administration sets other than sets used for lipids or blood products every 96 hours • Assess the need for the central line daily Catheter-Associated Urinary Tract Infections (CAUTI) Definition [21]: The Infectious Disease Society of America (IDSA) has defined CAUTI through the following criteria: (1) indwelling urinary catheter for more than 48 h after insertion; (2) one sign or symptom includ- ing fever, suprapubic tenderness, costovertebral angle tenderness, urgency or dysuria; and (3) urine culture with more than 10 5 colony-forming units
4. Appropriately use safety devices whenever avail- able:
a. Always activate safety features. b. Never circumvent safety features.
Infection Control Practices for Special Lumbar Puncture Procedures According to the CDC [15]: Bacterial meningitis following myelogram and other spinal procedures (e.g., lumbar puncture, spinal and epidural anesthesia, intrathecal chemotherapy) has been reported previously. Face masks are effective in limiting the dispersal of oropharyngeal droplets and are recommended for the placement of central venous catheters. Precautions During Aerosol-Generating Procedures Procedures that generate small particle aerosols; aerosol-gener- ating procedures (APG) such as bronchoscopy, endotracheal intubation, and extubation; CPR, and open suctioning of the respiratory tract have been associated with transmission of infectious agents to healthcare personnel, including M. tuberculosis , SARS-CoV, and N. meningitides . Protection of the eyes, nose, and mouth, in addition to gown and gloves, is recommended during performance of these procedures in accordance with standard precautions listed on the CDC’s website [3].
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