Introduction Central line-associated bloodstream infections (CLABSIs) are defined as infections that occur mainly when a patient is catheterized and germs invade the blood steam via the catheter that is placed in a large vein to ensure the patient gets the necessary fluids, medication or even blood and speedy medical tests in some cases(vdh.virginia.gov). The severity of the infection depend on various factors, like hospitalization length and catheter-related factors, among many others (vdh.virginia.gov).
According to the National Center for Emerging and Zoonotic Infectious Diseases, a Division of Healthcare Quality Promotion, about 18,000 ICU patients experienced CLABSIs and another 23,000 patients in other areas of the hospital had CLABSI, in 2009 alone (Department of Health and Human Services, 2011).
Although facts and statistics are disturbing, Central line-associated infections can be preventable, thus save the lives of thousands of people that die each year from CLABSIs. All it needs is a powerful collaboration between health care providers, medical care locations, patients and governments alike to promote prevention by following the CDC infection prevention guidelines.
Impact of CLABSI to patient safety and quality
Since blood stream infection occur to patients both inside Intensive Care Units and outside them, it is extremely important all CDC infection prevention guidelines are followed like a Bible. A patient that gets central line associated blood stream infection has a fever and they also notice reddish skin and/or soreness in the area around the central line (cdc.gov). In case this occurs, health care providers are obliged to run tests to determine whether there is infection present (cdc.gov).
Interventions to correct the problem
Like in any other disease or medical condition, prevention plays a leading role in avoiding a health-related problem. Taking precaution measures can in many times prove lifesaving. It is believed that bundle interventions are highly effective when trying to prevent Central line-associated blood stream infections (Furuya et.al, 2011). Findings of a study that was conducted in U.S Intensive Care Units has shown that Central Line Bundle elements have indeed proven to be effective in preventing CLABSI. More analytically, Central Line Bundle has appeared to reduce infection rates in the Intensive Care Units of the National Healthcare Safety Network hospitals (Furuya et.al, 2011). There are five interventions in Central Line Bundle, which of course include hand hygiene and antisepsis of the skin with chlorhexidine (Furuya et.al, 2011). Other than that, “maximal barrier precautions; [] optimal catheter site selection, with avoidance of the femoral vein for central venous access in adult patients; and daily review of the line necessity, with prompt removal of unnecessary lines” (Furuya et.al, 2011) are also recommended. However, bundled policies are not enough; hospitals need to improve the implementation of bundle elements as well (Furuya et.al, 2011).
Other than preventive interventions, ambulatory and acute care are also important. Outpatients also receive central venous catheters on various cases, like when a patient is on an oncology treatment, receives hemodialysis or is parenteral nourished (Kallen et.al, 2010). In terms of numbers, in about 30 percent of patients receiving hemodialysis a central venous catheter is used; in fact, approximately 80 percent of those patients actually start their hemodialysis treatment with a catheter, not to mention cancer patients, who on their two thirds use a catheter for a long time span (Kallen et.al, 2010). According to a study conducted in North Carolina, it is estimated that 1 in 3 patients that had central line associated blood stream infections were outpatients and intravascular devices were found to be the core reason for those infections (Kallen et.al, 2010). So, it is of great necessity that ambulatory care is intense and is provided with proper care. Some suggestions could include appropriate maintenance of the catheters and regular evaluation of whether the patient needs a catheter or not, so that any unnecessary catheters are removed, hence bring the risk of blood stream infections to the lowest possible levels (Kallen et.al, 2010).
Disinfecting injection ports and catheter hubs prior inserting the catheter, achieving skin antisepsis via chlorhexidine use, frequent dress changes have also been found effective in preventing blood stream infections (Kallen et.al, 2010). As a matter of fact, it is found that nonintact dressing create lapses in central venous catheter care and is closely associated with blood stream infection to patients in Intensive Care Units and non-Intensive Care as well (Kallen et.al, 2010). Studies have also shown that mechanical valves also increase the rates of blood stream infection, so, before gaining full knowledge on the reason why there are so many and complex connectors, it is strongly suggested that all manufacturer’s recommendations are strictly followed (Kallen et.al, 2010). Moreover, to patients that undergo hemodialysis, and only them, a topical antimicrobial ointment should be applied “to the exit site during dressing changes” (Kallen et.al, 2010), as it is proven that it helps reduce that central line associated blood stream infection rates. However, the aforementioned intervention is not suggested to other patients other than those that receive hemodialysis, because ointments are believed to have been related to fungal infections and drop the system’s immune, whch means that the patient becomes more prone to microbial infections (Kallen et.al, 2010).
CLABSI and Nurse Leadership.
Nurse leadership is extremely important in reducing central line associated blood stream infections as nurses are the ones that are directly responsible for maintaining catheters according to infection prevention guidelines (ahrq.gov). In fact, nurses are the main care givers that interact with patients and must ensure that their patients’ health is safe. Unit nurses “review and audit catheter maintenance policy and practices” (ahrq.gov). Nurses, alongside the rest of the staff need to know the infection rates per week (ahrq.gov), so they can evaluate their provided care and make any necessary arrangements and adjustments to improve patients’ health and avoid even further the risk of blood stream infections.
Education and leadership can improve the CLABSI outcomes.
In order to effectively prevent central line associated blood stream infections it is crucial that the staff members can abide by the CDC infection prevention guidelines. However, to be able to abide by the guidelines they need to be properly educated and trained in regards inserting and properly maintaining central venous catheters (Kallen et.al, 2010). The reason why staff needs to be educated is because “Educational interventions designed to improve knowledge about recommended procedures have been shown to decrease rates of CABSIs” (Kallen et.al, 2010). Supplementary, it is proven that blood stream infection surveillance is significant, as gathering information from blood stream infection rates can assist in reducing secondary blood stream infections, especially to patients that receive hemodialysis (Kallen et.al 2010).
The Agency for Healthcare Research and Quality, a division of the U.S Department of Health and Human Services mentions that although blood stream infections kill as many as breast cancer does per year, they are also preventable (ahrq.gov). Moreover, significant reductions can be accomplished if a “senior leader commits to a goal of zero” (ahrq.gov) and assigns staff members as leaders for the hospital’s units, who should be accountable for monitoring and presenting blood stream infection rates and their personal findings on blood stream infections to their senior leaders (ahrq.gov).
Conclusion
Central line-associated blood stream infections are very common to patients both in Intensive Care Units and outside them and the same applies to outpatients as well. Although blood stream infection can be deadly and actually kill as many people as breast cancer does annually, it can be prevented by following the infection prevention guidelines that include proper hand hygiene and maintenance of catheters. Leadership and education are significant factors that can effectively help reduce the blood stream infection rates, given that well-educated and trained staff and leaders that monitor and apply all procedures and measures that ensure patient safety and health have been identified as producing results. Leadership qualities of nurses can help monitor each patient’s health and prevent patients from getting infected, by proper tube maintenance and reporting to the unit leaders any findings or concerning indications that could imply possible blood stream infection.
References:
Agency for Healthcare Research and Quality (2013), Tools for Reducing Central Line-Associated Blood Stream Infections. Retrieved from: http://www.ahrq.gov/legacy/qual/clabsitools/clabsitoolsap9.htm
Centers for Disease Control and Prevention (2011), Central Line-associated Bloodstream Infections: Resources for Patients and Healthcare Providers. Retrieved from: http://www.cdc.gov/HAI/bsi/CLABSI-resources.html
Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, et al. (2011) Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections. PLoS ONE 6(1): e15452. doi:10.1371/journal.pone.0015452
Kallen Alexander, Patel Priti, O'Grady Naomi, and Weinstein Robert, (2010), Preventing Catheter-Related Bloodstream Infections outside the Intensive Care Unit: Expanding Prevention to New Settings. Oxford Journals: Clinical Infectious Diseases: Volume 51, Issue 3, Pp. 335-341. Retrieved from: http://cid.oxfordjournals.org/content/51/3/335.full
Virginia Department of Health (2013), Central Line-Associated Bloodstream Infections. Retrieved from: http://www.vdh.virginia.gov/epidemiology/surveillance/hai/clabsi.htm
