Tools for decreasing central line-associated bloodstream infections (CLABSI)

Central line-associated bloodstream infections (CLABSI) occur when bacteria or viruses enter the bloodstream through a central venous catheter, which is often placed in a large vein in the neck, chest, or groin to give medication or collect blood for medical tests. Because central lines access a major vein and can remain in place for weeks or months, they are much more likely to cause serious infection.

CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable. The Centers for Disease Control (CDC) and U.S. Department of Health & Human Services provides guidelines and tools to the healthcare community to help end CLABSIs.

CLABSI prevention

Healthcare providers should follow recommended central line insertion practices to prevent infection when the central line is placed, including:

• Perform hand hygiene.
• Apply appropriate skin antiseptic.
• Ensure that the skin prep agent has completely dried before inserting the central line.
• Use all five maximal sterile barrier precautions: sterile gloves, sterile gown, cap, mask, large sterile drape.
• Once the central line is in place, follow recommended central line maintenance practices.
• Remove a central line as soon as it is no longer needed. The sooner a catheter is removed, the less likely the chance of infection.

Here are some ways patients can protect themselves from CLABSI:

• Research the hospital, if possible, to learn about its CLABSI rate.
• Speak up about any concerns so that healthcare personnel are reminded to follow the best infection prevention practices.
• Ask a healthcare provider if the central line is absolutely necessary. If so, ask them to help you understand the need for it and how long it will be in place.
• Pay attention to the bandage and the area around it. If the bandage comes off or if the bandage or area around it is wet or dirty, tell a healthcare worker right away.
• Don’t get the central line or the central line insertion site wet.
• Tell a healthcare worker if the area around the catheter is sore or red or if the patient has a fever or chills.
• Avoid touching the tubing as much as possible, and do not let any visitors touch the catheter or tubing.

In ddition, everyone visiting the patient must wash their hands—before and after they visit.

Evidence-based tools

The Agency for Healthcare Research and Quality has made available tools that will help ICUs implement evidence-based practices and eliminate CLABSI. When used with the CUSP (Comprehensive Unit-based Safety Program) Toolkit, these tools dramatically reduced CLABSI rates in more than 1,000 hospitals across the country.

The infection prevention tools are based on four principles in the CUSP toolkit:

1. Engage: How will this make the world a better place?
2. Educate: How will we accomplish this?
3. Execute: What do I need to do?
4. Evaluate: How will we know we made a difference?

1.Engage. First make the CLABSI problem real by identifying a patient on your unit who suffered needless harm from a CLABSI and share that patient's story with your colleagues. Ask them if this is the kind of care they would want for their family, if this is care they are proud of, and if this is the best your unit can do.

Post the number of patients who developed a CLABSI and the total number of CLABSI cases for the previous year on your unit. Post a trend line so nurses and physicians can see at a glance the unit's CLABSI rate and how it changes over time. Post the number of days (or weeks or months) since the unit's last CLABSI. Use formal and informal opportunities to talk about the intervention and about unit-specific infection rates. Raising awareness among unit staff members of evidence-based practices will help eliminate CLABSI.

2.Educate. Make sure your staff members understand how they can reduce CLABSI. Numerous interventions have reduced the incidence of CLABSI and the ensuing morbidity, mortality, and costs. In addition, the CD), the Society of Critical Care Medicine, the Society of Healthcare Epidemiologists of America (SHEA), the Infectious Disease Society of America (IDSA), and several other organizations have developed evidence-graded guidelines to prevent catheter-related infections. Several of the guideline recommendations are supported by clinical trials or systematic reviews.

3.Execute. Implement a checklist. Creating independent redundancies through the use of a checklist is an effective technique to monitor whether or not providers adhere to care processes. Some organizations require a nurse to be present bedside during all central line insertions and to complete a checklist during every central line insertion. Using a checklist allows nurses to serve as an independent, redundant check to encourage physician adherence to evidence-based practices.

Pilot test the checklist on your unit for one week and interview several nurses regarding the form's clarity, the data collection burden, and any needed modifications.

Nurses can help in the effort to prevent and reduce CLABSIs by identifying best practices and opportunities for improvement, which enhance the facility's overall safety culture.

4.Evaluate. The first step in evaluating the success of CLABSI prevention efforts is to collect unit baseline CLABSI rates for the past 12 months. Next track unit CLABSI rates over time. Enter your data into a state-level database or the CDC's National Healthcare Safety Network. Although all units are urged to adopt the CDC's standardized definitions for CLABSI, definitions may still vary among hospitals. As long as your definition of a CLABSI remains constant, you can evaluate trends over time in infection rates.

And lastly, be sure to communicate your results with the entire team, patients and their families.

If your organization is still struggling with high rates of CLABSI, let Lippincott Professional Development Collection help enhance your organization’s clinical competency.

Part of the Lippincott Solutions institutional software suite, this evidence-based clinical education and competency validation solution includes over 370 online courses, most accredited for CE, and features a robust Program Set of Hospital Acquired Conditions courses that cover CLABSI, CAUTI, Pressure Injury Prevention, and more. For a free preview of the Lippincott Professional Development Collection courses, click HERE.