In the realm of healthcare-associated infections (HAIs), central line-associated bloodstream infections (CLABSI) are a significant concern. These infections can pose serious threats to patients’ health, leading to increased morbidity, mortality, and healthcare costs.
With a comprehensive understanding of CLABSI, its risk factors, and preventative strategies, patients and caregivers can collaborate with their healthcare providers to minimize its impact, resulting in better, more meaningful patient care.
Understanding CLABSI: What is it?
Central lines or central venous catheters (CVCs) are medical devices used in various healthcare settings to provide access to the bloodstream for administering medications, fluids, and nutrition, as well as for monitoring certain medical conditions. However, these lines can become a gateway for bacteria to enter the bloodstream, causing CLABSI.
CLABSI occurs when microbes, such as bacteria or fungi, colonize the catheter or the insertion site and then travel through the bloodstream, causing infection. The consequences of CLABSI can be dire, leading to extended hospital stays, increased healthcare costs, and in the worst cases, even death.
4 Risk Factors for CLABSI
There are several factors that contribute to the increased risk of CLABSI:
- Insertion practices: Improper insertion techniques or inadequate hygiene during catheter placement can lead to the introduction of pathogens.
- Catheter duration: The longer a central line remains in place, the higher the risk of infection. Prolonged catheter use provides more opportunities for microbes to colonize the device.
- Patient-related variables: Patients with compromised immune systems or underlying health conditions may be more susceptible to CLABSI.
- Environmental hygiene: Inadequate hygiene, poor infection control practices, and contaminated healthcare environments can facilitate pathogen transmission.
7 Preventative Strategies for Patients & Caregivers
Preventing CLABSI requires a multifaceted approach involving patients, caregivers, and providers. While healthcare providers should provide specific instructions tailored to the patient’s condition and type of central line, regular communication is still essential.
Seven effective CLABSI prevention strategies include:
- Expect providers to follow basic rules: Remember, providers should talk with their patients about their IV needs, working together to select the best IV and insertion site. Additionally, they should ask for help if they can’t get the IV after two attempts, clean the patient's skin before inserting the IV, and scrub the end of the IV each time they use it. When in doubt, refer to “I Save That Line: A Guide for Patients and Families” from Oley Foundation and the Association for Vascular Access (AVA)
- Discuss catheter site/exit site plan with your doctor: Before getting a new central line placed, talk to your physician about site selection. Catheter placement and exit site both play a role in CLABSI risk, and good site selection reduces risk and makes day-to-day catheter care easier.
- Proper dressing care: Aim to keep the dressing that covers the insertion site clean, dry, and intact. Caregivers should also follow provider recommended protocol for changing the dressing to ensure it is sterile and secured.
- Hand hygiene: Proper hand hygiene is a fundamental part of preventing CLABSI. Patients, caregivers, and providers should all thoroughly wash their hands with soap and water and/or use an alcohol-based hand sanitizer before and after touching the central line or any medical equipment. If you aren’t sure whether someone has washed their hands, ask!
- Line care: It’s essential to practice regular maintenance and central line care. Again, follow provider instructions for flushing the line with sterile solutions, checking for evidence of infection, and promptly addressing any concerns or changes at the insertion site.
- Infection control: Be aware of any signs or symptoms that might indicate infection, such as fever, redness, swelling, pain, or discharge at the insertion site. Any changes should be promptly reported to a healthcare provider.
- Avoid contamination: To minimize the risk of infection, avoid touching the insertion site or line any more than necessary. Using a securement device (e.g., Gus Gear’s Central Line Vest) can also prevent accidental pulling and tugging, and reduces the overall risk of central line complications, including infection.
The Collaborative Effort
While CLABSI infection rates are a serious concern, they’re not insurmountable. Preventing CLABSI requires a collaborative effort among patients, caregivers, healthcare providers, and administrators. It calls for commitment to evidence-based practices, ongoing education, effective communication, and a culture of patient understanding and safety.