Summary: APSIC Guide for prevention of Central Line Associated Bloodstream Infections (CLASBI)
The recommendations provided for insertion are optimal site selection, hand hygiene, alcohol based chlorhexidine skin preparation and maximum barrier precautions (Ling et al 2016). It is important to know the proper catheter infection site because it can affect the risk of infection and phlebitis. It is preferred to use subclavian site for adult patients. Hand hygiene is also important because it provides protection before the catheter insertion and maintenance. There should be proper aesthetic technique. Alcohol based chlorhexhidine in skin preparation is the standard procedure used in central and peripheral venous catheters. Lastly, maximum barrier precautions must be done such as wearing of sterile gloves, gown, cap, and mask. Full body sterile drape must also be used in covering the patient. Aside from these, a daily review of the central venous catheters must be done since the longer the time the catheter is left in place, the higher the risk of CLASBIs. Hubs on CVCs must also be disinfected because they are common source of bacteria. For the proper dressing, it is preferred to use the transparent semipermeable dressings that gauze dressings. Administration sets or systems must be changed routinely as well. Most importantly, the model of improvement approach with multidisciplinary process stakeholders must be adopted in the central line insertion.
Summary: Advances in Prevention and Management of Central Line—Associated Bloodstream Infections in Patients with Cancer
The article talks about central line and how important it is for cancer patients. According to the article, central venous catheters are considered as the life line of cancer patients (Raad & Chaftari 2014). There is a large percentage of these patients who have long term CVC. It is reported that for every 1000 CVC days in the United States, there is a 1.5 rate of central line associated bloodstream infections. If a more conservative rate will be followed, it means that 400,000 episodes of CLASBI happens annually among patients with cancer. So the yearly cost of CLASBI is estimated to be $18 billion.
The diagnosis of CLASBI and its definition is also provided in the article. CLASBI is defined to have local and non specific manifestations at the CVC insertion. It may also be subtle or absent in the cancer patient. However, there is a new definition that is called mucosal barrier injury laboratory confirmed bloodstream infection. This is for patients with suspected CLASBI and can possibly have gastrointestinal source. For those with MBI, it is better to use the definition catheter related bloodstream infection. Prevention of CLASBI was also discussed. The use of chlorhexidine when inserting catheter, barrier precautions, hand hygiene, avoid femoral sites, and removing of CVC are the necessary steps that must be taken since they are proven to decrease the risk of CLASBI. However, the problem is that not everyone follow these components. It was found out that only 17% to 38% comply with these rules. It is suggested to use antimicrobial impregnation coating of catheters since it can decrease the risk of CRBSI. Antimicrobial lock chelators were also created to replace the heparin based intraluminal locks. Lastly, the strategies for managing CLASBI were also identified based on pathogens suc as coagulase negative staphylococci, staphylococcus aureus, candida, gram negative bacilli, and gram positive bacilli.
References:
Lin Ling, M. A Apisarnthanarak, N. Jaggi, G Harrington, K. Morikane, L Thu, P. Chong, V. Villanueva, Z Zong, J. Jeong, C. Lee. (2016). APSIC Guide for prevention of Central Line Associated Bloodstream Infections (CLASBI). Antimicrobial Resistance and Infection Control.
Raad, Issam and A Chaftari. (2014). Advances in Prevention and Management of Central Line—Associated Bloodstream Infections in Patients with Cancer. Retrieved from http://cid.oxfordjournals.org.
