Central Line Associated Bloodstream Infection

Central Line Associated Blood Stream Infection

The Department of Health introduced the National Patient Safety Goals in the year 2002 to address different challenges affecting the adult patients. One of the aims is the prevention of Central Line Associated Blood Stream Infection (CLABSI). In particular, Central Venous Catheters (CVC) is indispensable in the caring of seriously ill individuals (O’Meara & Nagarsheth, 2015). However, the use of CVC introduces the risk of CLABSI to the patients.

In the Intensive Care Unit, CLABSI affects up to 7% of all the patients with CVC. As a result, there is an increase in the direct cost of healthcare, prolonged stay in the hospital, and ICU mortality. In the United States, nurses insert nearly 8 million Central Venous Access devices (CVAD) yearly. Marschall et al. (2014) argue that despite the use of the best aseptic techniques in maintenance and insertion of CVAD, 2 in 20 cases are associated with CLABSI. The attributed mortality per occurrence is 25%. In addition, the government spends more than $30, 000 to treat each infection and this translates to 2.3 billion dollars a year. The use of vascular access device has increased in nonhospital settings, although CLABSI numbers are steady.

The Center for Disease Control’s list of CLABSI prevention guidelines remains a benchmark for the care of all intravascular catheter infections. It suggests that nurses should replace dressings after seven days, when loosened, or when soiled. Additionally, they should replace intravenous tubing after three days. Lastly, the caregivers must replace the tubing used to administer lipid emulsions and blood products within a day of infusion initiation. The CDC claims that at any given day, 54% of all adult patients in the Intensive Care Unit have a CVC (Centers for Disease Control Prevention, 2013).

Furthermore, the nurses should prevent CLABSI by conducting skin cleansing of the tube insertion site. Mostly, povidone-iodine is a recommendable disinfectant during maintenance of intravascular devices. Moreover, the prevention of CLABSI entails educating nurses, replacement of occlusive dressing after a week, and performance of infection surveillance. Others include the utilization of maximal barrier precautions such as large sterile drape, sterile gown, cap, mask, and gloves. The nurses must also adhere to proper hand hygiene and the use of chlorhexidine gluconate in the preparation of insertion site. In case the infection rates are high, caregivers should impregnate catheters with antimicrobial agents. Experienced doctors ought to educate nurses on the proper care of CVC to reduce the amount of CLABSI.

Understandably, evidence-based practices can curtail CLABSI. Therefore, healthcare systems and hospitals focus on the implementation of CLABSI prevention strategies to cut on the healthcare cost and to minimize the responsibilities of caregivers. Nevertheless, hospitals cannot succeed in the prevention and treatment of CLABSI unless the medical practitioners employ both technical and adaptive forms of leadership in addressing the issue (Costello et al., 2014). The acknowledgment of these two complementary yet distinct components underscores how the education and engagement of nurses are fundamental in minimizing the infection rates. Given that the efforts have bore fruits in selective healthcare facilities, there is a renewed effort to appreciate the organizational complexities that affect the implementation of evidence-based practices in hospitals.

In summary, the application of technology and educational approach has ensured the control and elimination of CLABSI in some settings. However, knowledge gaps remain despite the progress. For instance, the preventive measures are only useful in ICUs, but on the outside, there is limited information on reduction strategies. Undeniably, the majority of CVCs in the United States are in non-Intensive Care Unit settings, hence the importance of initiating a research agenda to target such demography.

References

Centers for Disease Control and Prevention (CDC. (2013). Reduction in Central Line-Associated Bloodstream Infections among Patients in Intensive Care Units--Pennsylvania, April 2001-March 2010. MMWR. Morbidity and Mortality Weekly Report, 54(40), 1013.

Costello, J. M., Morrow, D. F., Graham, D. A., Potter-Bynoe, G., Sandora, T. J., & Laussen, P. C. (2014). Systematic Intervention to Reduce Central Line–Associated Bloodstream Infection Rates in a Pediatric Cardiac Intensive Care Unit. Pediatrics, 121(5), 915-923.

Marschall, J., Mermel, L. A., Fakih, M., Hadaway, L., Kallen, A., O’Grady, N. P., & Yokoe, D. S. (2014). Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S89-S107.

O’Meara, L., & Nagarsheth, K. H. (2015). Central Line Associated Blood Stream Infection. Encyclopedia of Trauma Care, 303-304.