Central line-associated bloodstream infection

Central line-associated bloodstream infection

Introduction

Central venous catheters play a crucial role in the management of critically ill patients admitted to the intensive care unit. The CVCs are used in the administration of intravenous fluids during resuscitation, which helps in hemodynamic parameters monitoring as well as administration of intravenous medication. ICU utilizes various interventions such as invasive procedures that may trigger the development of nosocomial infections among the patients. CLABSI develops within two days of placing a central line. Among all the healthcare-associated infections, CLABSI is the most expensive to manage because it requires the use of broad-spectrum antibiotics (Choi et al., 2018). Besides, the infection increase the duration of stay in the hospital among the patients. The majority of the CLABSI are preventable when proper surveillance, aseptic technique, and management strategies are correctly used.

Prevention strategies

Selection of catheterization site

There are three mainly used sites for the placement of central venous catheterization, which are subclavian vein, internal jugular vein, and femoral vein. The sites are associated with the occurrence of infection, mechanical and thrombotic complications, but the risk depends on the site that is used. The subclavian vein is the best site because it reduces the entry of bacteria and helps in reducing CLABSI occurrence. The femoral vein should be avoided as much as possible, especially when the patient can be considered for other sites of CVC because of the increased risk of developing thrombotic and infectious complications in comparison to subclavian and internal jugular sites (Jackson et al., 2017). Despite the fact that the femoral site is suitable for the insertion of CVC, it is essential to place it on a different site primarily if the catheter i

s anticipated to be used for more than two days. Both multi-lumen and single catheters are used in critical care. The type of venous catheter has a significant impact on the probability of subsequent infection and bacterial colonization. Despite the fact that multi-lumen catheters are more efficient when administering intravenous infusions and medications, it increases the risk of infections because of several pathways for the bacteria (Choi et al., 2018). It is also essential to use catheters that are impregnated with antibiotics because it helps in reducing the risk of developing the infections.

Catheter insertion

A sterile insertion technique should be used because it is vital in maintaining the lowest rates of developing CLABSI. The health care providers should undergo an aggressive capacity building and training on measures of catheter insertion.  Thorough hand hygiene helps in reducing the transmission of infection-causing agents. The clean hands should be done with sterile gloves. The clinician doing the insertion should strictly use aseptic technique, which includes full-body drape and maximal sterile barrier when inserting the catheter (Choi et al., 2018). The skin of the insertion site should be cleaned with 2% chlorhexidine and ultrasound guidance should be utilized to reduce the number of attempts and prevent mechanical complications(Jackson et al., 2017). The femoral vein site should be avoided completely, rather subclavian vein should be the vein of preference, especially when using non-tunneled catheters.  Any CVC that is no longer in use should be removed.  In case there was any catheter that was placed during an emergency, ensure to remove it before 48 hours elapses because its aseptic nature is not assured.

Maintenance and dressing of catheters

Mostly CVCs are always sutured to the skin to secure it from being dislodged. Despite the fact that suturing is the most secure means of ensuring that the catheter remains in place, it increases the risk of skin infections. Therefore, it is essential to use sutureless securement devices that can secure the CVCs without penetrating the skin.  Sutureless securement devices use strong adhesive wings to keep the catheter in place. When using the catheter caps, it must be cleaned with an antiseptic solution such as chlorhexidine to preventive the entry of pathogenic organisms (Jackson et al., 2017). All the injection ports, catheter hubs, and connections should be disinfected before administering any medication or accessing the line. All the sets that are used in the administration of fluids should be strictly changed after every 96 hours except those used in the administration of blood products and lipids, which should be changed immediately they have been used. The health care provider should access the need for using the catheter daily to avoid the remaining catheter on the patient’s body when it is not useful and needed.

Catheter removal

The risk of bacteria colonization increase with the increase in catheter duration, therefore, increasing the risk for CLABSI (Choi et al., 2018). When there is a suspected sign of bloodstream infection such as fever and sepsis, then catheter removal should be done immediately.

Conclusion

Prevention of CLABSIs among critically ill patients requires the application of multiple strategies. The strategies run from capacity building and training of health care providers who insert the catheters, proper handwashing, and use of sterile gloves. Also using antiseptic such as chlorhexidine to clean the site in which the catheter is to be inserted, and the use of sterile barriers among the catheter inserters helps in preventing the risk of pathogen transmission. Besides, novel technologies can also be used, such as the use of catheters impregnated with antibiotics, disinfection of catheters caps before infusion, and the use of sutureless securement devices play a vital role in reducing the risk of developing CLABSI.

References

Jackson, S. S., Leekha, S., Magder, L. S., Pineles, L., Anderson, D. J., Trick, W. E., … & Lowe, T. J. (2017). The effect of adding comorbidities to current centers for disease control and prevention central-line–associated bloodstream infection risk-adjustment methodology. infection control & hospital epidemiology, 38(9), 1019-1024.

Choi, J. U., Choi, N. J., Hong, S. K., Kim, T. H., Keum, M. A., Kim, S. R., … & Shin, S. D. (2018). Central Line-Associated Bloodstream Infection Prevention by Central Venous Catheter Management Staff in the Surgical Intensive Care Unit. Journal of Acute Care Surgery, 8(2), 65-70.