CLABSI

Central Line-Associated Bloodstream Infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through a central venous catheter. Central venous catheters are tubes placed in a large vein in the neck, chest, arm, or groin to give medications, fluids, blood, or nutrition to patients or to perform certain medical tests quickly. CLABSIs can lead to severe illness, prolonged hospital stay, and increased mortality.

Causes and Risk Factors

CLABSIs are primarily caused by a lack of proper sterile technique during the insertion of the central line or improper care of the site after insertion. Common organisms responsible for CLABSIs include Staphylococcus aureus, Coagulase-negative staphylococci, Enterococci, and gram-negative bacilli. Risk factors for developing a CLABSI include the length of time the central line is in place, the type of central line, the patient's underlying medical conditions, and the quality of care and maintenance of the central line.

Prevention

Prevention of CLABSIs is a critical component of hospital infection control practices. Strategies include:

• Using maximal sterile barrier precautions during central line insertion
• Choosing the optimal site for insertion to minimize infection risk, with the subclavian site preferred in adult patients
• Applying chlorhexidine for skin antisepsis
• Ensuring proper hand hygiene before handling the catheter
• Removing unnecessary central lines

The Centers for Disease Control and Prevention (CDC) provides guidelines for the prevention of CLABSIs, emphasizing the importance of education and training for healthcare personnel involved in the insertion and maintenance of central lines.

Diagnosis

Diagnosis of CLABSI involves a combination of clinical evaluation and laboratory testing. Symptoms of a bloodstream infection may include fever, chills, or hypotension. Laboratory diagnosis typically involves cultures of blood samples from both the central line and a peripheral site. A diagnosis of CLABSI is made when the same organism is grown from both sites and there is no other apparent source of infection.

Treatment

Treatment of CLABSI usually requires the removal of the infected central line and initiation of appropriate antibiotic therapy. The choice of antibiotics depends on the suspected or confirmed pathogens causing the infection. In some cases, if the patient's condition allows, the central line may be removed and replaced over a guidewire after antibiotic therapy has been initiated.

Complications

Complications from CLABSIs can be severe and include sepsis, endocarditis, and osteomyelitis. The risk of complications increases with the duration of infection and the presence of underlying medical conditions.

Conclusion

CLABSIs are a significant cause of morbidity and mortality in hospitalized patients but are largely preventable through strict adherence to evidence-based infection control practices. Ongoing education and training of healthcare personnel, along with surveillance and feedback of infection rates, are essential components of a successful CLABSI prevention program.