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Infections: how can you prevent them?

21 Mar 2016

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

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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