CLABS Infection Prevention Case Study

The burn unit clinical team consisting of physicians, nurses, pharmacists, and infection preventionists at a tertiary hospital, part of a large healthcare system in the mid-Atlantic area, recognized an upward trend in CLABSI, despite the success in reducing CLABSI in other units in the hospital. While formal research was not conducted, efforts to reduce the infections throughout the hospital were associated with evidence based practice initiatives recommended and published by the CDC (2011), The steps in the initiative, also known as bundles and were initiated after the healthcare system collaborate group’s work. The hospital wide interventions using the CLABSI prevention bundles resulted in a reduction over the overall CLABSI infection
rate of XX in 2015 XX in 2016. Refer to figure X for the CLABSI incidence in 2015. Concern over the spike in CLABSI in the burn unit prompted further discussion among the clinical team and the infection prevention team soliciting analysis the cases of CLABS infections to consider possible cases that may have resulted from a wound infection.
Identification of CLABSI were determined based on the criteria according to the NHIS and CDC. In burn patients the wounds pose a threat of causing a secondary blood stream infection. However, per the CDC definition, if there was no other infection identified and the patient had a central line, the infection would be classified as a CLABSI. As defined by Rafla and Tredget (2011), it is beneficial to clearly identify the responsible bacterial flora of burn wounds, its prevalence and bacterial resistance in order to make fast and reliable therapeutic decisions. In addition, the proper identification was needed to prevent inaccurate reporting to CMS and other payers. The clinical and the infectious disease team decided it was important to develop an algorithm in order to accurately identify the site and source of infection and to promote the appropriate use antimicrobial
therapy.
A pharmacy specialist t and infectious disease physician developed an algorithm to address actions when a burn wound infection was suspected. (see fig 2) The information was presented to the infection prevention committee IPC. Discussion surrounded the benefit and risks to the intervention and the secondary benefit of antimicrobial stewardship, a national agenda and healthcare organization goal.
Pharmacy and Therapeutics Committee
After vetting at the IPC meeting, the plan and algorithm for wound surveillance was endorsed by the Pharmacy and Therapeutics committee members, ant the medical executive Committee.
Burn Injury and Cellulitis Algorithm The purpose of an algorithm is to assign a set of actions to clinical criteria.
As identified in Figure 2, the algorithm starts with a suspicion for infection. QUOTE FROM DR. MOFFA. If there is no suspicion for infection, standard burn wound care will be implemented. This care includes_________. If it is determined that there is suspicion for cellulitis or burn wound infection, standard burn care is still provided , but a wound punch biopsy is obtained to identify the specific organism. The length of initial burn injury is considered and the specific l is selected. ______________. The antibiotic selection will be dependent on the date of the initial burn injury. Why? QUOTE FROM DR. MOFFA. Cefepine and cefazolin….what is the
difference?