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Preventing Central Line-Associated Bloodstream Infections: Do You Bundle?

  • Authors: Marin H. Kollef, MD
  • CME/CE Released: 12/8/2010
  • Valid for credit through: 12/8/2011, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for surgeons, anesthesiologists, operating room nurses, hospitalists, intensivists, preventionists, infectious disease specialists, physician assistants, general and advanced practice nurses, patient safety/risk management professionals, and healthcare administrators.

The goals of this activity are to:

  • Disseminate critical information as a foundation for change about central line-associated bloodstream infections (CLABSIs); and
  • Improve adherence to evidence-based interventions proven to reduce the rate of CLABSIs.

Upon completion of this activity, participants will be able to:

  1. Identify patient populations most at risk for CLABSIs
  2. Apply evidence-based strategies for eliminating CLABSIs
  3. Assemble the components of a central line bundle
  4. Recognize deviations from best practices for preventing CLABSIs


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Marin H. Kollef, MD

    Professor of Medicine, Washington University School of Medicine, St. Louis, Missouri; Director, Critical Care Research and Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri


    Disclosure: Marin H. Kollef, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Merck & Co. Inc.; Pfizer Inc.; Astellas Pharma, Inc.; Covidien
    Served as a speaker or a member of a speakers bureau for: Merck & Co. Inc; Pfizer Inc.; Astellas Pharma, Inc.

    Dr. Kollef does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

    Dr. Kollef does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


  • Tara Herrmann, PhD

    Scientific Director, Medscape, LLC


    Disclosure: Tara Herrmann, PhD, has disclosed no relevant financial relationships.

Nurse Planner

  • Susan L. Smith, MN, PhD

    Scientific Director, Medscape LLC


    Susan L. Smith, MN, PhD, has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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    For Nurses

  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 1.00 contact hour(s) of continuing nursing education for RNs and APNs; 0.25 contact hours are in the area of pharmacology.

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Preventing Central Line-Associated Bloodstream Infections: Do You Bundle?

Authors: Marin H. Kollef, MDFaculty and Disclosures

CME/CE Released: 12/8/2010

Valid for credit through: 12/8/2011, 11:59 PM EST


The following test-and-teach case is an educational activity modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and will then read evidence-based information that supports the most appropriate answer choice. Please note that these questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the case, there will be a short post-test assessment based on material covered in the activity.

Introduction of Patient Case

A 56-year-old, obese man weighing 127 kg is transferred to the intensive care unit (ICU) of your hospital with a diagnosis of acute pancreatitis. His symptoms began 5 days earlier when the patient was admitted to a 150-bed community hospital for abdominal pain. Ultrasound examination of the right upper quadrant reveal no gallstones, and the common bile duct and pancreatic duct appear normal. Serum lipase peaked at 1470 U/L.

The patient has a right femoral triple-lumen catheter that was placed on the day of admission at the outside hospital, which is now 5 days old. Total parenteral nutrition was begun 3 days earlier, and includes daily intralipids. Antibiotics have been administered for 4 days, including vancomycin 1 g every 12 hours and ciprofloxacin 400 mg every 8 hours. His vital signs are as follows: blood pressure, 86/55 mm Hg; heart rate, 124 beats per minute with a normal sinus rhythm; respiratory rate, 26 breaths per minute; and core temperature, 38.9°C.

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A CT scan of the abdomen shows necrotizing pancreatitis; a minimal amount of ascites that are nonhemorrhagic; and normal kidneys, liver, bowel, and spleen (Figure 1). However, the patient's urine output has been < 20 mL in the past 4 hours. His bladder pressure is 14 mm Hg. In addition, he has not had a bowel movement in over 24 hours. You order a 1-L bolus of lactated Ringer's solution with no change in vital signs or urine output. Norepinephrine is begun and titrated to keep the mean arterial pressure at or above 60 mm Hg.

Figure 1. Necrotizing pancreatitis.

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