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NHSN: CLABSI
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS
58
Nursing
Graduate
01/18/2013

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Term
CLABSI
Definition

CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION.

LCBI = LABORATORY CONFIRMED PRIMARY BLOOD STREAM INFECTION.

 

 

Term
IS THERE A MINIMUM PERIOD OF TIME THAT THE CENTRAL LINE MUST BE IN PLACE IN ORDER FOR THE BSI TO BE CONSIDERED CENTRAL-LINE ASSOCIATED?
Definition

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.

Term
DEFINE A CENTRAL LINE
Definition

INTRAVASCULAR CATHETER

AT OR CLOSE TO MAJOR VESSELS

INFUSION, W/DRAW BLOOD,

HEMODYNAMIC MONITORING

Term

GREAT VESSELS

(11 OF THEM!)

Definition

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

COMMON/EXTERNAL ILIAC VEINS;

INTERNAL JUGULAR VEINS; BRACHIOCEPHALIC VEIN

Term

TEMPORARY VS. PERMANENT

CENTRAL LINES

Definition

TEMP = NON-TUNNELED

PERM = TUNNELED OR IMPLANTABLE

Term

IS AN INTRODUCER IS CONSIDERED AN

______________________

CATHETER.

Definition
INTRAVASCULAR
Term

IN NEONATES,

WHAT TYPES OF LINES ARE

CONSIDERED CENTRAL LINES?

Definition

UMBILICAL ARTERY AND VENOUS

CATHETERS

Term

TRUE OR FALSE:

THE LOCATION OF THE INSERTION SITE

AND

THE TYPE OF DEVICE ARE VASC CATHS

Definition
FALSE
Term

THE TRANSFER RULE:

IF THE BSI DEVELOPS IN A PATIENT WITHIN ____ HOURS

OF TRANSFER,

INDICATE THE __________ LOCATION ON THE INFECTION REPORT

Definition

48 HOURS

TRANSFERRING LOCATION

Term

CLABSI DEVELOPS WITHIN

48 HOURS OF TRANSFER

TO A SNF:

REPORT TO ___

___ ADD'L CENTRAL LINE DAYS ARE RECORDED

Definition

NHSN

NO ADD'L CENTRAL LINE DAYS

Term

3 CRITERIA THAT CAN BE APPLIED

FOR

LCBIS

CRITERIA 1 & 2:  AGE RANGE

CRITERIA 3:  AGE RANGE

Definition

CRITERIA 1 & 2:  ANY AGE

CRITERIA 3:  < OR = 1 YR OF AGE

Term

LCBI

CRITERION #1:

PATHOGEN CULTURED FROM ONE OR MORE BLOOD CX; AND,

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

Definition

ONE OR MORE BLOOD CX BOTTLES POS.

AND

IS NOT R/T AN INFECTION

AT ANOTHER SITE

Term

EXAMPLE OF CRITERION #1:

PT W/ PICC INSERTION

JUNE 1

ON JUNE 5 W/ CONFUSION, CHILLS.

WHAT MUST GROW POSITIVE

Definition

BLOOD CULTURES

POSITIVE, AND NOT RELATED TO AN INFECTION AT ANOTHER SITE

Term
WHAT DOES "ONE OR MORE BLOOD CULTURES" MEAN?
Definition

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

POSITIVE BLOOD CULTURE

Term

WHAT ARE NOT CONSIDERED

"RECOGNIZED PATHOGENS"?

Definition

COMMON COMMENSALS

(NORMAL FLORA)

Term

GIVE EXAMPLES OF

"RECOGNIZED" PATHOGENS

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

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.

Definition
COMMON COMMENSAL CULTURED FROM 2 OR MORE BLOOD CULTURES DRAWN ON SEPARATE OCCASIONS
Term

GIVE EXAMPLES

OF

COMMON COMMENSALS

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

Definition

DIPTHEROIDS (CORYNEBACTERIUM SPP., NOT C. DIPTHERIAE)

BACILLUS SPP. (NOT B. ANTHRACIS)

PROPIONIBACTERIUM SPP;

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

VIRIDANS GRP STREPTOCOCCI

Term

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 ____________.

Definition

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)

Term

BLOOD DRAWS FOR BLOOD CULTURES

 ON MONDAY AND THURSDAY

ARE OKAY TO MEET CRITERIA

2 AND 3

FOR CLABSI

Definition
FALSE
Term

BLOOD DRAWS FOR BLOOD CX

ON MONDAY AND TUESDAY

OR MONDAY AND WEDNESDAY

ARE ACCEPTABLE

TO MEET CRITERIA 2 AND 3

FOR CLABSI

Definition
TRUE
Term

CLABSI CRITERIA 2 AND 3:

PEDIATRIC BLOOD CX BOTTLES

ONLY ONE BOTTLE MAY BE INNOCULATED PER DRAW,

THEREFORE, TO MEET THIS CRITERION ...

Definition
TWO WOULD HAVE TO BE CULTURE-POSITIVE
Term

EXAMPLE OF NEONATAL CLABSI

PER CRITERION 3

(T OR F):

BLD CX POS ON TUES AND SAT

Definition

FALSE

THE TIME BTW THESE CX

EXCEEDS THE 2 DAY PERIOD

FOR BLOOD DRAWS

Term

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.

Definition

TRUE.

TWO BOTTLES.

LESS THAN 2 DAYS APART.

COMMON COMMENSAL.

Term

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?

Definition

PT WOULD HAVE HAD TO HAVE HAD

NO SYMPTOMS NOR

LABORATORY EVIDENCE

OF INFECTION

ON ADMISSION

Term

LCBI CRITERION #2?:

PT ADM FOR MI

CENTRAL LINE PLACED DAY 1 ADM

T 102 DAY 4 ADM

ONE BCX POS. FOR STAPH EPI

Definition

NO.

PT DOES NOT MEET CRITERIA.

IF PT HAS ANOTHER BCX POS

FOR STAPH EPI, THEN PT

MEETS CRITERIA

FOR LCBI#2.

 

Term

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-?

Definition

COMMON COMMENSAL

IS CX FROM 2 OR MORE BLD CX

DRAWN ON

SEPARATE OCCASIONS

Term

CAN LCBI CRITERIA

FOR #1 AND #2

BE USED FOR INFANTS AND CHILDREN?

Definition
YES
Term

BABY BORN W/OUT

S/SX OF INFECTION

DAY 2 BABY FUSSY, IRRITABLE

BCX POS PSEUDOMONAS AERUGINOSA

WHICH CRITERION IS MET?

Definition
CRITERION 1 FOR LCBI
Term

DETERMINING "SAMENESS"

OF 2 ORGANISMS:

BCX REPORTS GENUS AND SPECIES

(S. EPIDERMIDIS)

ANOTHER BCX REPORTS GENUS

(COAG NEG STAPH)

 

Definition

ASSUME THE ORGANISMS ARE THE SAME.

REPORT THE MORE SPECIFIC ORGANISM IN NHSN.

Term

THE FOLLOWING ARE THE RESULTS FROM TWO BLOOD DRAWS:

*COAG NEG STAPH

*STAPH EPIDERMIDIS

WHICH WOULD YOU REPORT

IN NHSN

Definition
S. EPIDERMIDIS
Term

DRAWING BLOOD CULTURES

SHOULD BE DRAWN FROM ...

A VASCULAR CATHETER?

Definition

TWO TO FOUR SEPARATE SITES,

NOT THRU A VASCULAR CATHETER

Term

True or False:

there is ONE definition for BSI

when monitoring

CLABSI

Definition
TRUE
Term

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

Definition

1.  recognized pathogen

2.  skin organisms; 2 BCs; positive clinical sx

3.  2 BCs; positive clinical sx

Term
The location for a CLABSI must be an _________ area (ie, where pts are housed __________) and where denominator data can be collected.
Definition

inpatient area

housed overnight

Term
Date of CLABSI event is the date the _____ s/sx of the BSI were identified, or, the date the ___________ was drawn, whichever comes first.
Definition

first s/sx of infection

or

date the first positive blood cx was drawn

Term
For an ICU patient, in the Risk Factors section, circle "yes" if the pt had a _______ ____ during the __ hour period before event date.
Definition

ICU patient

central line in

48 hours prior to the event

Term

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

permanent/temporary

______ lines in place

Definition

one or more

permanent/temporary

central lines

(RISK ASSESSMENT)

Term

NICU patients

birthweight in grams

Does it change with age, as pt gains weight?

Definition

No. 

It is the wt in grms at birth.

Term

Signs and symptoms of infection:

Match

any patient       fever; decr temp; apnea;

decreased T

< 1 year of age     fever; chills; hypotension

Definition

infants:

fever; hypothermia; apnea; bradycardia

any pt:

fever; chills; hypotension

Term

BSI contributed to death:

Circle yes if

the BSI directly caused death

OR

_________________

Definition

directly caused the death

or

exacerbated an existing condition

which then led to death

Term

For CLABSI events, the Pathogen field

will autofill as

___.

Definition

Yes. 

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

form.

Term

Pathogen and antibiotic

information are organized by

* gm ___/____ organisms

* f______ organisms

* o_____ organisms

Definition

gm neg/gm pos organisms

fungal organisms

other organisms

Term

Up to _____ organisms can be recorded for each BSI.

Each pathogen is listed in _____ of __________.

Definition

three organisms per BSI

organisms listed in order of importance

Term

S = susceptible

I = ____________

R = resistant

NS = _______________

S-DD = susceptible/dose dependent

N = __________

Definition

I = indeterminate

NS = non-susceptible

N = not tested

Term
What do you do if the identified organisms are not included in the gm +/gm - or fungal sections?
Definition

List the pathogen under "Other".

Record the entire antibiogram as reported by micro.

Term

Collecting Denominators for CLABSI:

ICU/Other locations:

# ________ on the unit

# patients on the unit w/ one or more __

Definition

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

Term

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

 

Definition

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

Term

NICU denominator data

CLABSI:

# pts in ea ______ category on the unit

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

Definition

NICU denominator data/CLABSI:

birthweight category

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

Term

CLABSI rate =

# _______ identified

_________________________

# _________ ______ days

X 1000

Definition

CLABSI rate =

# CLABSIs identified

_________________________

# central line days

X 1000

Term

CLABSIs are stratified by:

* ICU or _____ location

*________ Care Area (___)

- temporary/permanent line

* NICU

- ___________category

Definition

ICU or other care area

specialty care area SCA

NICU:  birthweight category

Term

CLABSI

SIR = _______ ________ ratio

SIR = (O) ________ HAIs

________________________

(E) ________ HAIs

Definition

SIR = standardized infection ratios

observed HAIs

_______________

expected HAIs

Term

The CLABSI SIR allows you to

* summarize your data for ______

locations, or, for

________ locations.

Definition

single locations

or multiple locations

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

Term

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

______________.

Definition
greater than or equal to 1.
Term

CLABSI

Device Utilization (DU) Ratio

Central Line DU Ratio =

#_______ days

____________________

# ________ days

Definition

DU ratio for central lines:

# central line days

______________________

# patient days

(no multiplier for the DU ratio)

Term

Using CLABSI data to protect patients:

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

Definition

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

which is aggregated and risk-adjusted

Term

You can compare your CLABSI data to itself over time.

This will identify t_____,

and "d___ ____" to determine

the cause.

Definition

trends

drill down

determine cause

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