Central Line Associated Blood Stream Infections

Central Line Associated Blood Stream Infections

Introduction

Central line-associated bloodstream infection is a type of infection that is associated with having a catheter inserted in a major vein, usually for the delivery of medications, nutrition or fluids. Bloodstream infections are often serious enough to cause a longer hospital stay or even death.

Thesis Statement

Central line-associated bloodstream infection can be prevented through proper management of the central lines and the removal of these lines when they are no longer needed.

Discussion Analysis

Surveillance Activities and Monitoring CLABSI Rates

EP 8 requires that the home care and hospice organization measure CLABSI rates, monitor compliance with best practices or evidence-based guidelines, and evaluate the effectiveness of prevention efforts (TJC, 2008). Organizations may also need to begin collecting surveillance data on CLABSI. Collecting these data require active, prospective surveillance of CLABSI that develop 48 hours after admission while a patient is receiving care in the home. Any trained person can report the infection, but for accuracy and consistency, the Infection Preventionist should review the surveillance report, and the clinical record if needed, to make a final determination as to whether the patient met the surveillance. It is important that consistent surveillance methods and definitions be used to allow for data comparison between home care and hospice organizations. The total number of patient cases that met this surveillance definition should be aggregated on either a monthly or quarterly basis (if there is a low sample size). In addition, the total number of central line device days for the month for all home care and hospice patients who had a central line in place should be collected.

Central Line Necessity

EP 17 requires that the home care and hospice organization routinely evaluate the necessity of all CVCs and recommend the removal of nonessential catheters (TJC, 2008). Often central lines remain in place because of convenience for the patient by providing a reliable means of obtaining a blood sample or accessing the patient's venous system for scans and other tests "just in case" it is needed. They also remain in place because healthcare personnel have previously not considered recommending them for removal. The longer the central line remains in place, the higher the risk of infection over time.

Once the central line is removed, so is the risk of CLABSI. The CDC recommends that any intravascular catheter be promptly removed when it is no longer essential (CDC, 2002b). The IHI, NQF, SHEA/IDSA recommend reviewing the medical necessity of the central line on a daily basis in an acute care setting (IHI, 2008; NQF, 2006;SHEA/IDSA, 2008) to prevent any unnecessary delays in promptly removing a central line that is no longer clearly needed for the patient's care. This time frame can be easily met in an acute care setting; however, daily review for a home care or hospice patient may not be considered reasonable as the nurse often does not even make daily home visits.

The organization's policies and procedures should include the frequency in which the central line will be ...