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Fluids & Electrolytes
Catheter-related bloodstream infections (CRBSI) are potentially life-threatening to patients who need I.V. therapy. These infections also add an enormous burden to our healthcare system, with billions of dollars spent annually to treat them.
For many years, the prevailing attitude was that a certain number of CRBSI is inevitable, even acceptable. Using CDC data as a benchmark, healthcare facilities aimed to keep CRBSI rates at or below published CDC rates. But we now know that our standards should be higher. Clinical research has proven that CRBSI can be prevented. The only acceptable goal is zero.
Many facilities that have incorporated the "central line bundle" promoted by the Institute for Healthcare Improvement have reduced the number of CRBSI to near zero. A bundle is a group of evidence-based interventions shown to improve outcomes when used together. Adopting the bundle is an important step toward eliminating CRBSI. But most components of the bundle focus on the catheter insertion procedure, which takes less than an hour. After insertion, the catheter may remain in place for weeks, months, even years. Preventing CRBSI for the duration requires ongoing attention to a major source of infection after catheter insertion: the catheter hub.
Think about all the tasks you do that involve the catheter hub when you manage an I.V. line. Each time you flush the catheter, administer a medication, disconnect the intermittent administration set, or withdraw a blood sample, you introduce a significant number of organisms into the catheter's lumen.
The next time you hold a catheter hub in your hand, think about what you can do to reduce the level of contamination being introduced. Did you clean the needleless connector correctly? Was the male luer end of the administration set kept sterile between uses? Have you limited the number of times the catheter hub is accessed-for example, by drawing a blood sample from a peripheral vein instead of the catheter?
On page 7, you'll find our I.V. Infection Control Survey. Please take a few minutes to answer it. Responses from nurses like you will help us gauge whether real-world nursing practice is in step with current guidelines. We'll report the results later this year.
Achieving and maintaining a zero rate of CRBSI requires attention to catheter management for as long as the catheter is in place. So when you hold that catheter hub, think about the fact that preventing CRBSI is in your hands-literally!!
Lynn C. Hadaway, RN-BC, CRNI, MEd
Lynn C. Hadaway is president of Lynn Hadaway Associates, Inc., Milner, Ga., and a member of the Nursing2009 editorial advisory board. Meet Ms. Hadaway when she speaks at the Nursing2009 Symposium in Orlando, Fla., May 6 to 9.
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