Central Line Associated Bloodstream Infection (CLABSI)
CLABSI has become such a volatile HAI. Given all the penalties and public reporting, no wants to have one. And hospitals that do have one now have to report these data publicly - leading to all kinds of problems - Vineet Chopra
image by: Mateusz Zawadka
HWN Suggests
APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI)
Central line–associated bloodstream infections, or CLABSIs, are associated with increased morbidity, mortality, and health care costs. It is now recognized that CLABSIs are largely preventable when evidence based guidelines are followed for the insertion and maintenance of Central Venous Catheters (CVC)... The catheter insertion site affects the risk for catheter-related infection and phlebitis... Femoral catheters are associated with a higher risk of infection and deep venous thrombosis, than internal jugular or subclavian catheters and should also be avoided, where possible. A subclavian site is preferred in adult patients and factors such as potential for mechanical complications and risk…Articles of Interest
A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection
Among patient safety initiatives, preventing central line–associated bloodstream infection (CLABSI) has been a case study in success. Progress in reducing CLABSI relates to several elements, including evidence-based checklists for vascular catheter insertion; improved efficacy of modern skin antiseptics, such as alcohol-containing chlorhexidine; and greater awareness, leading to focused efforts directed at the problem. The concept of a standardized approach as exemplified by a catheter bundle is now being used to improve catheter maintenance and selection of the most appropriate vascular catheter to reduce CLABSI risk.
Are Central Lines Placed in the ED Associated with Higher Risk for Bloodstream Infections?
The rate of bloodstream infections for central lines placed in a single emergency department was comparable to the rate for lines placed in the intensive care unit.
Central line infections
A central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection (BSI) in a patient who had a central line within the 48 hour period before the development of the BSI, and that is not related to an infection at another site.
Central Line-Associated Bloodstream Infections (CLABSI)
This blueprint outlines the steps that frontline staff can follow to prevent Central Line-Associated Bloodstream Infections.
Emergency Department Central Line-associated Bloodstream Infections (CLABSI) Incidence in the Era of Prevention Practices
The CLABSI rates in this academic medical center ED were in the range of those reported by the ICU. The effect of ED CLABSI prevention practices requires further research dedicated to surveying ED CLABSI rates.
Hot topics in diagnosing, preventing, and treating central line associated bloodstream infections
As each additional day that a CVC remains in place increases the risk of infection, daily rounding and surveillance tools should be used to evaluate the necessity of CVC regularly. Whenever feasible, IV medications should be transitioned to PO to minimize unnecessary catheter manipulation. Line surveillance programs are effective at identifying high-risk CVCs for further interventions and to remove unnecessary CVCs.
Line infection
It's fine to insert a dirty/crash central line without full sterility, but it must be removed within <48 hours. If a line is correctly designated as dirty and removed within <48 hours this will not cause CLABSI.
Prevention of Central Line-Associated Bloodstream Infections
Central venous catheters (CVCs) are commonly used in critically ill patients and offer several advantages to peripheral intravenous access. However, indwelling CVCs have the potential to lead to bloodstream infections, with the risk increasing with an array of characteristics, such as catheter choice, catheter location, insertion technique, and catheter maintenance. Evidence-based guidelines have led to a significant reduction in the incidence of bloodstream infections associated with CVCs. The combination of guideline implementation and newer technologies has the potential to further reduce morbidity and mortality from infections related to CVCs.
Prevention of Central Line–Associated Bloodstream Infections
CLABSI can lead to considerable mortality, morbidity, and cost. An estimated 250,000 CLABSIs occur in patients yearly, and about 80,000 of those are estimated to occur in the intensive care unit (ICU) setting. Since central venous catheters (CVCs), or central lines, are most often used in the ICU setting, much of the work on prevention and management of CLABSI has been within the ICU population
Recommendations for The Prevention of Central Line Associated Bloodstream Infections
Filling the catheter lumen with a supratherapeutic concentration of an antibacterial or antiseptic solution and maintaining it until catheter hub re-access is known as an anti-infective lock. This method has shown potential in reducing the risk of CLABSI. Ongoing research is focusing on determining the optimal antimicrobial agent or combination, their concentration, and the duration of lock therapy.
Rumination and Rumbling on Vascular Access
CLABSI has become such a volatile HAI. Given all the penalties and public reporting, no wants to have one. And hospitals that do have one now have to report these data publicly - leading to all kinds of problems.
Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections
These guidelines have been developed for healthcare personnel who insert intravascular catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, healthcare infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing.
Ultrasound-guided left subclavian central venous catheterisation
In our opinion the easiest and most convenient way to set up a central line.
Resources
Shrug Technique for US-guided subclavian lines
The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
CDC
Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system – but they are preventable.
StatPearls
A central line-associated bloodstream infection (CLABSI) is defined as the recovery of a pathogen from a blood culture in a patient who had a central line at the time of infection or within 48 hours before the development of infection. Most cases are preventable with proper aseptic techniques, surveillance, and management strategies.
