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Author(s)

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

Disclosures

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.

Editor(s)

Tara Herrmann, PhD

Scientific Director, Medscape, LLC

Disclosures

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

Nurse Planner

Susan L. Smith, MN, PhD

Scientific Director, Medscape LLC

Disclosures

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

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

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

CME/CE

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

Authors: Marin H. Kollef, MD
CME/CE Released: 12/8/2010
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 12/8/2011, 11:59 PM EST

Start Activity

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:

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

Disclosures

Author(s)

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

Disclosures

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.

Editor(s)

Tara Herrmann, PhD

Scientific Director, Medscape, LLC

Disclosures

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

Nurse Planner

Susan L. Smith, MN, PhD

Scientific Director, Medscape LLC

Disclosures

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

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

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

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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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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
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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.

Page 1 of 7

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Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on www.medscapecme.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Author(s)

Marin H. Kollef, MD

Editor(s)

Tara Herrmann, PhD

Nurse Planner

Susan L. Smith, MN, PhD

CME Reviewer(s)

Nafeez Zawahir, MD

CME/CE

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

Target Audience and Goal Statement

Disclosures

Author(s)

Marin H. Kollef, MD

Editor(s)

Tara Herrmann, PhD

Nurse Planner

Susan L. Smith, MN, PhD

CME Reviewer(s)

Nafeez Zawahir, MD

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

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

Introduction of Patient Case