Central Line Associated Bloodstream Infection (CLABSI): What you need to know

The intended audience for this Webliography is anyone interested in learning more about IV access, particularly central lines, their benefits vs. risks, and how to minimize those risks.

Central lines are necessary for many patients in the hospital or in the home setting.  They are indicated for a variety of uses, including but not limited to: long-term IV therapy, administration of multiple medications in the ICU, CVP monitoring in the ICU, administration of TPN, chemotherapy or other caustic medications with a high or low PH, and they are being utilized in an  increasing number of obese patients who wouldn’t otherwise have IV access.

As with everything in medicine, the risks vs. benefits must be considered prior to any treatment or procedure.  In many situations, IV access is unobtainable peripherally and a central line may be placed emergently.  Sometimes a central line is placed while a patient is undergoing surgery so that they can be monitored in the ICU.  They may have a need for multiple ports to infuse drips, blood, and continuous infusions.  Whatever the reason for central line placement, the possibility of a Catheter related blood stream infection is an important consideration, in terms of patient outcomes and cost.

A patient with a CLABSI will have an increased hospital stay of approximately 20 days!  Steps are being taken to minimize the possibility of this occurring and the research shows it can be done.  If you need more information about how to institute a program in your hospital, see the websites below:  

•Centers for Disease Control and Prevention (CDC):  Healthcare Associated Infections: Recovery Act

http://www.cdc.gov/HAI/recoveryact/index.html

The American Recovery and Reinvestment act of 2009 was designed to stimulate economic recovery in various ways, including strengthening the Healthcare system of the country and reducing costs.  $50 million was earmarked to support the states in the prevention and reduction of Hospital Acquired Infections (HAI).  Multiple links for patients and healthcare workers.  

•Centers for Disease Control and Prevention (CDC):  Central Line Associated Bloodstream Infection (CLABSI) Event

http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf

A document that addresses what a Central Line Associated Blood Stream Infection is, how it affects the patient and healthcare, and how to prevent it.

•Missouri Department of Health and Senior Services:  Definitions

http://health.mo.gov/data/hai/definition.php

Definitions regarding everything Central Line; Bloodstream Infections, what constitutes a Central Line Blood Stream Infection and defines how data is obtained and reported for hospitals in Missouri.

•Wiley Online Library:  Guidelines on the insertion & management of central venous access devices in adults. 

http://onlinelibrary.wiley.com/doi/10.1111/j.1751-553X.2007.00931.x/abstract

An article that lists major recommendations and guidelines for inserting a central line, choosing the most appropriate catheter for the patient, care and maintenance of the catheter, and managing and preventing catheter problems.

•National Institute of Nursing Research:  High compliance with “central line bundle” preventive practices can decrease infection rates in the ICU.

http://www.ninr.nih.gov/ResearchAndFunding/ResearchHighlights/

This article focuses on the bundling of Central Line Access elements and monitoring the outcomes when bundling recommendations are followed.

•Pubmed Central: Public Health Reports:  Estimating Health-care associated infections and deaths in U.S. Hospitals, 2002. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820440/

Deaths from nosocomial infections exceed the number of deaths from several of the top 10 leading causes of death listed in the U.S. vital statistics.  These numbers are cause for alarm and careful consideration by healthcare workers.

•U.S. Department of Health and Human Services:  ICUs in Michigan sustain zero Blood Stream Infections for up to 2 years. 

http://www.ahrq.gov/news/press/pr2011/clabsiicupr.htm

A report about a Michigan State hospital that obtained a zero infection rate with their central lines.  They used a comprehensive approach with a commitment to continuous quality improvement.  They followed the CDC recommendations and practice guidelines, using a check off system for staff placing lines using this form, available through Johns Hopkins website, here:  http://www.hopkinsmedicine.org/bin/y/j/IFC035_APP_C.pdf

•U.S. Department of Health and Human Services: Healthfinder.gov

Health care-related infection declined in 2010: CDC.

http://www.healthfinder.gov/news/newsstory.aspx?docid=658021

The CDC Prevention strategies are working!  Hospitals across the country are making progress and many have been recognized for improvements in their outcomes.   Read the article here:  http://www.hhs.gov/ash/news/20110502a.html

I chose the above websites for their validity.  The CDC, NIH, Dept. of HHS are all reputable sites with the domain of .gov.  Their articles are up to date and the authors are experts with credentials listed.