Infections: how can you prevent them?

21 Mar 2016

By: Kristy Bond, BSN, RN, manager, accreditation & patient safety

 

Tips to prevent central line infections (CLABSIs):

• Perform hand hygiene before insertion and donning sterile gloves
• Adhere to aseptic technique
• Use full-barrier precautions during central venous catheter (CVC) insertion (mask, cap, gown, sterile gloves, and sterile body drape)
• Perform skin antisepsis with >0.5 percent chlorhexidine with alcohol
• Choose the best site to minimize infections and mechanical complications
  • Avoid using the femoral vein for CVCs in adult patients
• Use a CHG dressing to cover site
• Promptly remove central lines when no longer medically necessary
  • Perform daily audits to assess whether central line is still needed and document why
  • Additional resources from AHRQ and the CDC

Tips to prevent catheter-associated urinary tract infections (CAUTIs):

• Only place urinary catheters when medically necessary
  • Acute urinary retention or bladder outlet obstruction
  • Need for accurate measurements of urinary output in critically ill patients
  • To assist in healing of open sacral or perineal wounds in incontinent patients
  • Patients that require prolonged immobilization
  • Perioperative use for selected surgical procedures
  • To improve comfort for end of life care
• Maintain strict aseptic technique throughout catheter insertion process
  • Use sterile gloves, drape, an appropriate antiseptic or sterile solution for periurethral cleaning, and a single-use packet of lubricant jelly for insertion
• Assess daily for medical necessity
• Post-operative Foleys should be Dc’d within 48 hours post procedure, if there is not an appropriate medical indication to continue them
• Additional resources from AHRQ and the CDC

Tips to prevent surgical site infections (SSIs):

• Decrease OR traffic
• Use preoperative chlorhexidine baths for patients
• Use appropriate antibiotic selection and timing – do not routinely use vancomycin
• Consider screening for staph aureus colonization and decolonize surgical patients
• Use impervious plastic wound protectors for GI surgeries
• Use monofilament non-absorbable sutures for skin closure
• Use alcohol-containing preoperative skin preparatory agent if no contraindications exist
• If possible remove drains within 24 hours
• Reduce allogeneic blood utilization
• Optimize patient prior to surgery to reduce risk factors for SSI:
  • Smoking cessation
  • Glucose management
  • Avoid hair removal unless necessary, use clippers, not shaving for hair removal if needed
  • Additional resources from AHRQ and the CDC