central line related blood stream infection

1st session CLABSI
Presented by : Dr.Hanadi Albasha
Infection control officer

Introduction
 An infection is considered a Healthcare-associated Infection (HAI) if the infection occurs
on or after the 3rd calendar day of admission to an inpatient location where day of
admission is calendar day 1.
 Acceptable documentation includes patient-reported signs or symptoms documented in
the chart by a healthcare professional.
 Physician diagnosis can be accepted as evidence of an infection only when physician
diagnosis is an element of the specific infection definition. For example, physician
diagnosis is not an element of any UTI criteria; therefore, physician diagnosis of a UTI
may not be used.
 • Infections occurring in newborns with date of event on hospital day 1 or day 2 are
considered infection present on admission.
 This would include infections acquired transplacentally (e.g., herpes simplex,
toxoplasmosis, rubella, cytomegalovirus, or syphilis) or as a result from passage through
the birth canal (e.g., Group B Streptococcus).
 Those with date of event on day 3 or later are HAI.
REF CDC JAN 2016
29-Oct-16 Ref CDC Jan 2016

Central line-associated BSI (CLABSI)
 A laboratory-confirmed bloodstream infection (LCBI) where
central line (CL) or umbilical catheter (UC) was in place for >2
calendar days on the date of event, with day of device placement
being Day 1,
 AND
 the line was also in place on the date of event or the day before.
 If a CL or UC was in place for >2 calendar days and then
removed, the date of event of the LCBI must be the day of
discontinuation or the next day to be a CLABSI.
 “Access” is defined as line placement, infusion or withdrawal
through the line. Such lines continue to be eligible for CLABSI
once they are accessed until they are either discontinued or the
day after patient discharge.

Laboratory-Confirmed
Bloodstream Infection Criteria
 LCBI 1
 Patient has a recognized pathogen identified from one
or more blood specimens by a culture or non-culture
based microbiologic testing methodwhich is
performed for purposes of clinical diagnosis or
treatment.
 AND
 Organism(s) identified in blood is not related to an
infection at another site.

Laboratory-Confirmed
Bloodstream Infection Criteria
 LCBI 2
 Patient has at least one of the following signs or symptoms: fever (>38.0oC),
chills, or hypotension .
 AND
 Organism(s) identified from blood is not related to an infection at another
site) .
 AND
 the same common commensal (i.e., diphtheroids [Corynebacterium spp. not C.
diphtheriae], Bacillus spp. [not B. anthracis], Propionibacterium spp., coagulase-
negative staphylococci [including S. epidermidis], viridans group streptococci,
Aerococcus spp., and Micrococcus spp.) is identified from two or more blood
specimens drawn on separate occasions, by a culture or non-culture based
microbiologic testing method
 Criterion elements must occur within the Infection Window Period (the 7-day
time period which includes the collection date of the positive blood, the 3
calendar days before and the 3 calendar days after).

 LCBI 3
 Patient ≤ 1 year of age has at least one of the following signs or symptoms: fever
(>38.0oC), hypothermia (<36.0oC), apnea, or bradycardia
 AND
 Organism(s) identified from blood is not related to an infection at another site.
 AND
 the same common commensal (i.e., diphtheroids [Corynebacterium spp. not C.
diphtheriae], Bacillus spp. [not B. anthracis], Propionibacterium spp., coagulase-
negative staphylococci [including S. epidermidis], viridans group streptococci,
Aerococcus spp., and Micrococcus spp.) is identified from two or more blood
specimens drawn on separate occasions , by a culture or non-culture based
microbiologic testing method
 Criterion elements must occur within the Infection Window Period, the 7-day
time period which includes the collection date of the positive blood, the 3
calendar days before and the 3 calendar days after.

 Salmonella spp. are excluded as pathogens for LCBI. These organisms
may be secondary BSIs but will not be reported as the sole pathogen in a
primary BSI.
 “two or more blood specimens drawn on separate occasions” means,
 1) that blood from at least two separate blood draws were collected on
the same or consecutive calendar days, and
 2) were collected in a manner which suggests that two separate blood
draw site preparations were performed.
 This will reduce misidentification of contaminated blood specimens as
LCBI. For example, blood specimens drawn from different sites (e.g.,
different venipunctures, a combination of venipuncture and lumen
withdrawal, or different lumens of the same central line), or at different
times.
 For pediatric patients, due to volume constraints, a blood specimen
may consist of a single bottle. Therefore, to meet this part of the
criterion, each bottle from two, single bottle blood draws would have to
be positive for the same common commensal.
 Catheter tip cultures are not used to determine whether a patient has a
primary BSI.

REFERENCES
 1CDC National and State Healthcare-Associated Infections Progress Report, published
 March 2014, available at http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-
report.pdf
 2 O’Grady, NP., Alexander, M., Burns, LA., Dellinger, EP., Garland, J., Heard, SO.,
 Maki, DG., et al. “Guidelines for the Prevention of Intravascular Catheter-related
Infections”. Clinical Infectious Diseases 52 (a): (2011): 1087-99.
 3 Clinical and Laboratory Standards Institute (CLSI). Principles and Procedures for
 Blood Cultures; Approved Guideline. CLSI document M47-A. Wayne, PA: Clinical and
Laboratory Standards Institute; 2007.
 4Baron, EJ., Weinstein, MP., Dunne, WM., Yagupsky, P., Welch, DF., Wilson, DM.
 Blood Cultures; Approved Guideline. Washington, DC: ASM Press; 2005.
 5 Lee, A., Mirrett, S., Reller, LB., Weinstein, MP. “Detection of Bloodstream Infections In
 Adults: How Many Blood Cultures are Needed?” Journal of Clinical Microbiology, Nov;
45(11): (2007): 3546-8.
 6 Klevens, RM., et al. “Sampling for Collection of Central Line Day Denominators in
 Surveillance for Healthcare-associated Bloodstream Infections”. Infection Control
Hospital Epidemiology. 27: (2006):338-42.

REFERENCES
 7 Thompson, ND., et al.” Evaluating the Accuracy of Sampling to Estimate
Central Line–Days:
 Simplification of NHSN Surveillance Methods”. Infection Control Hospital
Epidemiology. 34(3): (2013): 221-228.
 8 See, I., et al. ID Week 2012 (Abstract #1284): Evaluation of Sampling
Denominator Data to Estimate Urinary Catheter- and Ventilator-Days for the
NHSN. San Diego, California. October 19, 2012.
 9 Your guide to the Standardized Infection Ratio (SIR). October 2010.
 http://www.cdc.gov/nhsn/PDFs/Newsletters/NHSN_NL_OCT_2010SE_final.p
df
 10 Edwards et al. (2009). National Healthcare Safety Network (NHSN) report:
Data summary for 2006 through 2008, issued December 2009. Available at:
 http://www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.PDF
 11Dudeck, MA., et al. National Healthcare Safety Network (NHSN) Report,
Data Summary for
 2013, Device-associated Module. American Journal of Infection Control. 43(3):
(2015): 206-221.

For the record …
 Those are the last updated guidelines of 2016 .
 http://www.cdc.gov/HAI/bsi/bsi.html
 http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CL
ABScurrent.pdf

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central line related blood stream infection

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