DIAGNOSIS DAN

PENCEGAHAN BSI
(BLOOD STREAM INFECTION)
Pendahuluan
• Penggunaan alat IV tidak dapat dihindari
• Bertujuan untuk terapi cairan, pemeberian
darah, parenteral nutrisi maupun untuk
pemantauan hemodinamik.
• Komplikasi infeksi lokal maupun sistemik:
Endokarditis, Thrombophlebitis , IADP

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BSI

December 1, 2013
• Primary bloodstream infections (BSI):
Laboratory-confirmed bloodstream
infections (LCBI) that are not secondary to an
infection at another body site (CDC, 2016)

• CLABSI: Central Line Associated Blood

Stream Infections
primary bloodstream infections in patients
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with central lines
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Sites of possible contamination of
intravascular infusions

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Sources and Routes of
Transmission - 1
• Sources of contamination intrinsic or extrinsic
• Most microorganisms from the patient’s skin flora
• Contamination of device hub also a source of
infection
• S. aureus - 60 to 90% of infections

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 Sources and Routes of
Transmission – 2 (central line)
Hands of staff Flora del
paciente

Contamination of fluids Skin flora

Contamination of
insertion site

Injections ports

Contaminación de las 7
conexiones
Seed from
distant site
DIAGNOSE

• Kultur darah positif kuman patogen 1x/ lebih

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• Kuman teridentifikasi tidak berhubungan dengan infeksi
di tempat lain
Cont’d

• Ada min. 1 gejala: demam > 38, menggigil, atau hipotensi

• Kuman teridentifikasi tidak berhubungan dengan infeksi
di tempat lain
• Kuman komensal sama (Corynebacterium spp., Bacillus
spp., Propionibacterium spp., CONS, dll) teridentifikasi ≥ 2x9
dari darah
 Cont’d

• Umur < 1 tahun, Ada min. 1 gejala: demam > 38/ <36,
apnea, atau bradikardi
• Kuman teridentifikasi tidak berhubungan dengan infeksi
di tempat lain
• Kuman komensal sama (Corynebacterium spp., Bacillus
spp., Propionibacterium spp., CONS, dll) teridentifikasi ≥ 2x
dari darah 10
Cont’d

• Memenuhi kriteria LCBI1

Disertai :
• Pasien allogenic stemcell transplant disertai diare
• Pasien netropenia (ANC<500)
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 Cont’d

• Memenuhi kriteria LCBI2

Disertai :
• Pasien allogenic stemcell transplant disertai diare
• Pasien netropenia (ANC<500)
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 Con’t

• Memenuhi kriteria LCBI3

Disertai :
• Pasien allogenic stemcell transplant disertai diare
• Pasien netropenia (ANC<500)
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Prevention of Infections - 1
Main source of Prevention
infection
Infusion fluids Monitor sterilisation
Ensure fluid is pyrogen free.
Avoid damage to containers
Inspect containers
Addition of Aseptic technique
medications Sterile medications
Carry out procedures in the pharmacy.
Sterile device for accessing the system.
Single-dose vials
If multi-dose vials have to be used:
Refrigerate after opening
Wipe diaphragm with 70% isopropanol
Warming- Ensure no contamination 14
container Dry warming systems are preferred.
 Prevention of Infections - 2
Main source of Prevention
infection
Insertion of Thorough hand disinfection and sterile gloves
catheter Thoroughly disinfect the skin insertion site.
Catheter site Cover with sterile dressing
Remove catheter if signs of infection occur.
Inspect site every 24 hours.
Change dressing only when necessary.
Do not use antimicrobial ointments.
Injection ports Clean with 70% isopropanol and allow to dry
Close ports that are not needed with sterile stopcocks.
Changing of Replace no more frequently than 72 hours (blood and lipids
infusion set every 24 hours).
Thorough hand disinfection
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Use good aseptic technique.
General Comments - 1
• Routine changes of peripheral IV catheters not
required
• In adults recommendation to change every 72-96 hours to
reduce phlebitis
• In children should not be replaced routinely
• Routine replacement of central catheters not
necessary
• Central catheters used only when indicated
• Non-essential catheters removed
• Risk of infection increases with length of
catheterisation
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General Comments - 2
• Teflon or polyurethane catheters associated with
fewer infections
• Steel needles same rate of infection as Teflon
catheters
• Steel needles complicated by infiltration of IV fluids
• Well-trained staff to set up and maintain infusions
• Masks, caps, and gowns not necessary for insertion
of peripheral IV lines
• Use of non-sterile barriers will protect the operator if
blood exposure likely
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Protocol for peripheral
infusions - 1
• Place arm on a clean sheet or towel
• Hand hygiene (alcohol hand rub or antiseptic soap)
• Dry hands on a paper or unused linen towel
• Hand hygiene (gloves does not replace it)
• Not remove hair (if necessary clip, avoid shaving)
• Disinfect skin site, apply for 30 seconds and allow drying
• 0.5% chlorhexidine-alcohol, 2% tincture of iodine, 10% alcoholic
povidone-iodine, or isopropanol).
• Chlorhexidine products should not be used in
children younger than 2 months
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Protocol for peripheral
infusions - 2
• Cannula preferably in an upper limb
• Secure sterile dressing
• Transparent dressings allow inspection of the site
• Secure cannula, label with insertion date
• Assess need for catheter every 24 hours
• Inspect catheter daily
• Avoid cut downs, especially in the leg
• Cannulae and sets must be sterile
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Additional guidelines for
central catheters
• Selection of site
• Higher infections for jugular and femoral
• Maximum barriers
• Disinfect skin with 2% chlorhexidine/alcohol
• Change transparent dressings once a week or if soiled,
loose, or damp, gauze every two days
• Replace sets not for blood or lipids no more than 72 hours

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For CENTRAL LINE

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KEY PREVENTION STRATEGIES
in CENTRAL LINE

MAINTENANCE

• Daily line discussion

• Hand hygiene prior catheter
manipulation dressing change
• Aseptic technique prior to access “scrub the hub”
• Maintenance of secure
dressing over catheter entrance sites
• Aseptic technique for dressing changes
• Standard line changes 22

• Daily CHG bathing

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O’Grady et al, AJIC 2011

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Measures that should not be
considered as part of a general
prevention policy:
• Systemic antibiotic prophylaxis
• Topical use of antimicrobial ointments
• Routine replacement of central venous catheters
• Routine use of antibiotic locks for central venous
catheters
• Routine use of in-line filters
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