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Difficulty: EasyInfection Control and Hospital-Acquired Conditions

A 55-year-old male patient is admitted to the intensive care unit with septic shock secondary to a perforated appendix. The medical team decides to insert a central venous catheter for the administration of targeted vasopressor therapy and hemodynamic monitoring. The resident physician prepares to perform the procedure at the right subclavian vein site. To minimize the risk of a central line-associated bloodstream infection (CLABSI), the resident adheres to the hospital's standardized infection control bundle. The resident performs surgical hand antisepsis and dons a surgical cap, a mask covering the nose and mouth, a sterile gown, and sterile gloves. The skin at the insertion site is thoroughly prepped with a 2% chlorhexidine and 70% isopropyl alcohol solution and allowed to dry completely. Which of the following is the most appropriate additional intervention required to minimize the risk of a central line-associated bloodstream infection in this patient?

  1. Cover the patient entirely with a large sterile drape during the procedureAnswer
  2. B
    Administer a prophylactic dose of intravenous vancomycin prior to insertion
  3. C
    Apply a topical antibiotic ointment to the insertion site after securing the line
  4. D
    Replace the central venous catheter routinely over a guidewire every 72 hours
  5. E
    Obtain daily screening blood cultures from the catheter port

Answer

Covering the patient entirely with a large sterile drape during the procedure is the required additional measure to complete maximal sterile barrier precautions for central line insertion.
The most appropriate additional intervention to prevent a central line-associated bloodstream infection (CLABSI) is to cover the patient entirely with a large sterile drape during the procedure. This is a critical component of maximal sterile barrier precautions, which also mandates the operator wear a surgical cap, a mask, a sterile gown, and sterile gloves. The CDC and IDSA strongly recommend maximal sterile barriers during central venous catheter insertion as part of the evidence-based CLABSI prevention bundle, which has been proven to significantly reduce the incidence of hospital-acquired bloodstream infections.

Step-by-Step Solution

1
Analyze the patient scenario and the planned procedure.
The physician is inserting a central venous catheter in the intensive care unit and needs to strictly adhere to the evidence-based CLABSI prevention bundle.
Identifying the applicable infection control protocol is the first step in determining the missing requirements.
2
Review the components of the CLABSI insertion bundle already completed by the physician.
The physician has performed surgical hand antisepsis, applied chlorhexidine skin prep, and donned a surgical cap, mask, sterile gown, and sterile gloves.
Comparing performed actions against the standard bundle identifies what elements have already been addressed.
3
Identify the missing component of maximal sterile barrier precautions.
A large, full-body sterile drape is the only missing component of the maximal sterile barrier precautions required for this procedure.
Maximal sterile barriers mandate that in addition to the operator wearing full sterile personal protective equipment, the patient must be fully draped to maintain a wide sterile field.

Key Concept

The central line-associated bloodstream infection (CLABSI) prevention bundle requires maximal sterile barrier precautions, which includes the operator wearing a surgical cap, mask, sterile gown, and sterile gloves, as well as covering the patient entirely with a large sterile drape.
Estimated Time:1m 0s
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Topics

Infection Control and Hospital-Acquired Conditions

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