Central Line Associated Bloodstream Infections (CLASBI)

Lewis et al. explain in Medical-Surgical Nursing, a central line is a catheter placed into a large blood vessel for a patient who requires frequent or long-term access to the vascular system. The authors explain that catheters are used for the administration of high volume fluids, medications that are irritating (such as chemotherapy), long term pain medication, blood products, parenteral nutrition, and hemodialysis. Kaiser policy states four different types of central line used for patients: Centrally inserted catheters, peripherally inserted catheters, injection implanted ports and hemodialysis catheters. Centrally inserted catheters

Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.

Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.

People in the five boroughs, and throughout New York, regularly seek medical treatment. This may be due to a medical emergency, to monitor an ongoing condition or for a number of other reasons. When patients go in to receive treatment, they rarely expect that doctor negligence or errors may cause them worsened medical conditions or even death. However, medical mistakes are common, and often lead to a range of ailments, including central line-associated bloodstream infections.

Central venous catheters (CVCs) are frequently used in intensive care units (ICUs) for a number of reasons (measure central venous pressure, when peripheral veins are unable to be accessed, administration of medications/therapies and aspiration of blood samples) (Conroy, 2006, p. 98). Patients in this environment already have an increased risk of infection because of their treatments. Patient treatments commonly involve invasive devices or interventions (major surgery), antibiotic therapy (raises the risk of bacterial resistance) while steroid, chemotherapy and radiation therapy all suppress the immune system (Hatler, Hebden, Kaler, & Zack, 2010).

CLABSI is the acronym for central line associated blood stream infection. CLABSI are the third leading cause of hospital acquired infection (HAI). Central line associated infections are life threatening and is a common risk factor associated with central venous catheters (CVC). Peripherally inserted central catheters are a common type of CVC used. Research is conducted to determine whether there is a benefit to reducing CLABSI with use of PICC lines that are coated with antimicrobials. This research compares the impact of chlorhexidine impregnated verses non- chlorhexidine PICC with the risk of CLABSI and VTE development in patients that are immune suppressed, critical care or trauma patients.

As mentioned above, there are a multitude of practices that are practice to decrease the prevalence of central line associated blood stream infections. To prevent central line associated bloodstream infections there are several steps before and during the insertion process as well as after the insertion of the line to decrease the risk of developing an infection. To begin with, it is important to avoid using the femoral vein for central venous catheter insertion is possible (Hsu, 2014). Avoiding the femoral vein is important because it is consider a dirty area of the body; therefore, the preferred site for the insertion of these lines is the subclavian vein because it is considered the area that is least likely to be infected. Furthermore,

As a result of the risk factors that have been associated with this medical procedure, various strategies have been implemented to help reduce if not eliminate the threat of central venous related contagions post insertion. Some of these strategies include the following; disinfection of the needleless connectors, hubs, as well as the injection ports before the use of the central venous catheter (Pongruangporn et al. 2013). Drawing from various research findings on the prevention of CVCs associated infections post insertion, the infection of the center, commonly referred to as the hub of the catheter as a result of the non-sterile access technique has been identified to be the main path for developing infections associated with the insertion of the catheter. Lowering contamination through

In 2012, there were of 1.7 million people in the United States had central line infections. In the past it was common to think that infections that occurs in hospitals were considered “inevitable” (The Joint Commission, 2012, p. 12). Fortunately now health care professionals are relying more on evidence based practices to help reduce central catheter associated infections. There are three ways healthcare professionals can help reduce these infections and that includes the use of chlorhexidine gluconate, management practices, and education.

The strain is also a cause of bloodstream infections, associated with breakages in the skin or the mucosal membranes from outer injuries or surgeries. The use of intravascular devices such as catheters, hemodialysis machines, or injection needles may also enable S. aureus to invade the bloodstream. Once the bacteria have entered the bloodstream, they can infect various organs, causing infective endocarditis, septic arthritis, and osteomyelitis. This disease is particularly prevalent and severe in the younger and older

Within the intensive care unit (ICU), one of the most important items or equipment utilized in management of patients is the central venous catheters (CVCs). These are typically devices that can allow intravascular access while terminating at any site close in proximity of the heart or in the neck around the great vessels. CVCs are vital for the management of critically ill and hospitalized patients as they provide or facilitate the procedures such as the medication infusion, blood sampling as well as hemodynamic measurement. Despite their importance, the CVCs are associated with increased cases of central line associated blood-stream infections (CLABSIs) in the healthcare facilities. These CLABSI are among the noted cases of hospital acquired infections for which Medicare cannot reimburse; and apart from the issues of reimbursement, these CLABSI are associated with lengthened hospital stay for patients, increased direct and indirect costs of treatment as well as significant compromise on health and wellness of the patient.

The author of the article provided the reader with good background information. There are statistics on how much central line infections decreased from 2001 to 2009 among ICU patients. In comparison, the author also provided statistics on CLABSI’s in acute care hospitals, which keep remaining high. CDC, Joint Commission, as well as the Center for Medicare and Medicaid Services goal of reducing the incidents of CLABSI was brought to the reader attention. The author acknowledged that there is a gap in the research about the possible strategies to reduce CLABSI rates outside of CCU. Although, there is no available research on current practices/ strategies that are being implemented in order to reduce CLABSI. Only one provided example is the study hospital.

Infections will occur if pathogens enter the urinary tract, and catheter-associated urinary tract infection will appear in patient’s body in most case. Germs are usually enter the urinary tract when the catheter is inserted or while the catheter stays in the patient’s bladder (Centers for Disease Control and Prevention, 2015).

Proper hygiene is important in the healthcare industry and also as a personal responsibility. Poor hygiene is attributed to various infections ranging from cholera to typhoid. CLABSI is an example of an infection caused by poor hygiene during surgical operations. The USA’s CDC (Centers for Disease) categorizes CLABSI as a Healthcare Associated Infection (HAI). The disease is widespread as there more than 1.7 million patients infected with HAIs such as CLABSI in the United States. Of all the HAIs contracted in healthcare institutions, CLABSI is the most common. This is due to the fact that more than half of the patients in the Intensive Care Unit (ICU) require a central line during their stay.

CLABSI is the acronym for central line associated blood stream infection. CLABSI are the third leading cause of hospital acquired infection (HAI). Central line associated infections are life threatening and is a common risk factor associated with central venous catheters (CVC). Peripherally inserted central catheters are a common type of CVC used. Research to determine whether there is a benefit to reducing CLABSI through use of PICC that are coated with antimicrobials are used. This research compares the impact of chlorhexidine impregnated verses non- chlorhexidine PICC with the risk of CLABSI and VTE development in patients that are immune suppressed, critical care or trauma patients.