PIAC Case Series
Case 02 - David, 4 Years Old - Answers
David is a 4 year old with developmental delay who required abdominal surgery for volvulus.
- He has not tolerated oral/enteral nutrition and has received TPN. On post-op day 6 he develops T=38.8 and WBC=15K
- The following day 2 of 2 blood cultures are positive for gm + cocci
1) How is a central-line associated bloodstream infection (CLA-BSI) diagnosed?
2) What organisms in blood culture are possible contaminants? Which organisms should definitely not be considered contaminants?
- Staphylococcus aureus
- Staphylococcus epidermidis (CONS)
- Pseudomonas aeruginosa
- Bacillus species
- Candida albicans
CLA-BSI diagnosed by:
- + blood culture with recognized pathogen (e.g. S. aureus), central line in place and no other evident source
- If blood culture + for pathogen of uncertain significance (e.g. CONS), need 2 positive cultures and sign/symptom (fever, chills, hypotension)
- Organisms likely contaminants = corynebacterium ("diptheroids"), bacillus (non-anthracis), propionibacterium
- Possible contaminants = coagulase-negative staph
- NOT contaminants = Staph aureus, Candida, Pseudomonas
3) What measures are undertaken to prevent CLA-BSI?
Measures undertaken to prevent CLA-BSI in all patients:
Line bundle for placement
- Site prep = chlorhexidine/alcohol (allow it to dry!)
- Full site drape on patient
- Full barriers on operator (cap, mask, gown, sterile gloves)
Optimal care of line
- scrub the hub" for any access; dry/intact dressing at all times
Daily review of necessity of line - remove if not needed!
Other measures to consider
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- Our standard is silver impregnated catheter; an antibiotic (minocycline/rifampin) impregnated catheter available - use if prior CLA-BSI or other high risk
- Some hospitals have shown decrease in CLA-BSI with daily chlorhexidine bathing in ICU patients