Central Line-Associated Bloodstream Infections (CLABSI)
Central Line-Associated Bloodstream Infections (CLABSI) are serious medical complications that occur when bacteria enter the bloodstream through a central venous catheter, commonly known as a central line. These catheters are essential in healthcare settings, particularly for patients requiring long-term treatment, as they allow for the delivery of medications, fluids, and nutritional support. CLABSIs are often associated with symptoms such as fever, chills, and irritation around the catheter insertion site, and they can lead to severe outcomes including extended hospital stays and increased healthcare costs.
The prevalence of CLABSI is notably high in intensive care units, where they represent a significant cause of hospital-related infections. Statistics indicate that thousands of CLABSI cases occur annually in the U.S., contributing to a considerable number of fatalities. Although CLABSIs can often be treated effectively with antibiotics, prevention strategies are crucial. Recommended practices include adherence to strict hygiene protocols during catheter insertion and maintenance, as well as the use of antiseptic techniques to reduce infection risk.
Patients should be aware of the symptoms of CLABSI to facilitate early detection and treatment. Recognizing the seriousness of these infections underscores the importance of proper medical care and vigilance in healthcare environments.
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Central Line-Associated Bloodstream Infections (CLABSI)
The central venous catheter, also called the central line, is a long, flexible, intravascular catheter that is equipped to distribute medicine, fluids, nutrients, or infusions; withdraw blood; or monitor heart function, for patients with hospital stays longer than several weeks. The thin catheter is typically inserted through a large vein in the arm or chest. It terminates near or close to the heart or one of its major vessels or veins. For hospital-limited insertions, the catheter can be inserted through the neck for more efficient removal once treatment is finished.
Central line–associated bloodstream infections (CLABSIs) occur when bacteria travel down the central line and enter the bloodstream. CLABSIs can cause fever, chills, red and sore irritations around the catheter insertion point, or sepsis. Such infections are most common in hospitals, particularly in intensive care units and wards. CLABSIs lengthen patients’ hospital stays, thus increasing the overall medical costs and the likelihood of dying while hospitalized.
Background
Central intravascular catheters are given for long-term medical treatment, typically associated with pain, infections, cancer, or nutritional supply. Central venous catheters can remain inserted for a longer period of time compared to an intravenous catheter (IV), which is inserted through veins located in the back of the patient’s hand or forearm. Central line catheterization is especially useful for long-term treatments, such as kidney dialysis as treatment for kidney failure. In addition, placement of the catheter end in close proximity to the heart, rather than near the skin surface, allows long-term treatment and more efficient distribution of medical fluids or blood, especially for heart-related diseases. Central venous catheters allow frequent blood drawing without constantly poking the patient with needles.
Three main central intravascular catheters are used in the medical industry: the peripherally inserted central catheter (PICC) line, the tunneled catheter, and the implanted port. PICC lines are injected through an arm vein rather than through the neck or chest. Tunneled catheters require additional surgery to insert the catheter through a neck- or chest-positioned vein under the skin, with an end of the catheter remaining outside of the patient’s skin. This position allows easy delivery for medical fluids, catheter security and stability, freedom for the patient to move around, and concealment as per the patient’s desire. The implanted port catheter is comparable to the tunneled catheter with the exception of its position under the skin. Tunneled catheters leave a portion of the catheter outside of the patient’s skin, whereas implanted port catheters have the entirety of it planted underneath the skin thus requiring the injection of medicine and medical fluids through the skin. Certain implanted port catheters have a small enclosure to collect medical fluid before slowly releasing it into the bloodstream and allow subsurface refilling. Implanted port catheters are less conspicuous and require minimal care as compared to tunneled catheters. Moreover, implanted catheters have the least impact on a patient’s daily routine out of the three types of central intravascular catheters.
Complications from the use of central intravascular catheters vary in levels of severity, though the most serious infections can often be effectively treated with antibiotics. Bleeding and mild pain are associated with the insertion of catheters into the vein and are among the milder complications. Blood clots may form in the blood vessels, particularly in arms, and can block the central line, thus requiring additional catheter flushing to minimize build-up and infections. Shifting of twisted or repositioned catheters can also cause complications and may require replacement. Moreover, chest insertions for central line catheters require great skill and may result in a collapsed lung (pneumothorax) if inserted incorrectly.
Overview
CLABSIs are one the leading causes of nosocomial, or hospital-related, infections. According to the World Health Organization (WHO) in 2016, approximately 80,000 catheter-related bloodstream infections per year are reported for intensive care unit (ICU) patients in the United States. Catheters are necessary for ICU patients, as they serve as the primary pathway for patients to receive nutritional and medical resources. The US Centers for Disease Control and Prevention (CDC) reported that 12 to 25 percent of CLABSI-diagnosed patients die, with the remainder often requiring extended hospital stays and accumulating hundreds of thousands of dollars’ worth of hospital expenses. The WHO also reports that in the United States, an estimated 250,000 cases of bloodstream infections (BSIs) result in as many as 62,000 deaths among all hospital patients (not just those in intensive or acute care) each year. A single CLABSI case can amount to $56,000 for treatment in the United States.
These infections are often curable using antibiotics, although the CDC has suggested prevention techniques to minimize the incidence of CLABSIs. In a 2011 CDC guideline checklist, the CDC suggests that clinicians perform daily audits on the necessity of performing central line insertions. Proper insertion practices—correct hand hygiene, aseptic technique (sterile gloves), and maximized sterile barrier practices using sterile gauze and medical clothing—can greatly minimize the onset of infections from the initial insertion stage. Moreover, appropriate antiseptic and antisepsis rinses ensure sterile environments during insertion. Wet, soiled, or dislodged dressings must be replaced as a precaution and for proper aseptic and sterile practices. The CDC also suggests that facilities prepare readily available kits with sterile and antiseptic supplies for proper insertion practices as well as periodic educational sessions to inform medical clinicians of the most current insertion procedures. Moreover, the CDC suggests consideration of supplemental insertion strategies, such as 2 percent chlorhexidine bathing, antimicrobial- or antiseptic-coated catheters, and chlorhexidine-coated dressings.
Although precautions can help minimize the risk of CLABSIs, it is still vital for patients with central lines to be able to recognize CLABSI symptoms. Infected persons typically become ill with fevers and chills within the first few days of infection. Moreover, the skin surrounding the catheter insertion point will become red and sore. These symptoms, along with a combination of laboratory tests—particularly the positive blood culture—can confirm the diagnosis of CLABSI. While it is possible for the infection to begin in a different location, the severity of the symptoms and blood results can help determine if the infection began at the central line.
Bibliography
California Department of Public Health. "Central Line–Associated Bloodstream Infection (CLABSI)." California Department of Public Health. State of California, 2016. Web. 23 May 2016.
Centers for Disease Control and Prevention. Bloodstream Infection Event (Central Line–Associated Bloodstream Infection and Non-Central Line–Associated Bloodstream Infection). N.p.: CDC, Jan. 2016. Digital file.
Centers for Disease Control and Prevention. Checklist for Prevention of Central Line Associated Blood Stream Infections. N.p.: CDC, 2011. Digital file.
Centers for Disease Control and Prevention. FAQs about Catheter-Associated Bloodstream Infections. N.p.: CDC, et al., n.d. Digital file.
Centers for Disease Control and Prevention. "Healthcare-Associated Infections (HAIs): Central Line–Associated Bloodstream Infection (CLABSI)." Centers for Disease Control and Prevention. CDC, 1 Mar. 2016. Web. 23 May 2016.
Martin, Laura J. "Central Line Infections—Hospitals." MedlinePlus. NIH, US Natl. Lib. of Medicine, 26 Feb. 2016. Web. 8 Aug. 2016.
Preventing Harm from CLABSI. Health Research and Educational Trust, 2017. HRET-HIIN, www.hret-hiin.org/Resources/clabsi/17/clabsi‗change‗package.pdf.
World Health Organization. "Patient Safety: Preventing Bloodstream Infections from Central Line Venous Catheters." World Health Organization. WHO, 2016. Web. 23 May 2016.