Central Line-Associated Bloodstream Infections (CLABSIs) are serious healthcare-associated infections. They occur when germs enter a patient’s bloodstream through a central line, leading to prolonged hospital stays, increased healthcare costs, and severe complications. Preventing CLABSIs is essential for patient safety.
Understanding CLABSI
A central line, or central venous catheter, is a thin, flexible tube inserted by healthcare providers into a large vein, typically in the neck, chest, or groin. Unlike regular IVs, central lines can remain in place for weeks or months, extending close to or inside the heart. Professionals use them for long-term medications, direct nutrition, or frequent blood draws, especially for critically ill patients. However, central lines create a pathway for germs to enter the bloodstream, potentially causing a CLABSI. These infections can lead to severe illness, extended hospitalizations, and increased healthcare expenses.
Core Prevention Strategies
Preventing CLABSIs involves a series of evidence-based practices implemented by healthcare providers, focusing on meticulous care throughout the central line’s placement and maintenance. These strategies aim to minimize the risk of germs entering the bloodstream through the catheter.
Hand Hygiene
Hand hygiene is a fundamental practice. Healthcare workers must thoroughly wash hands or use an alcohol-based rub before and after any contact with the central line or patient. This action significantly reduces germ transmission.
Maximal Sterile Barrier Precautions
During the insertion of a central line, healthcare providers use maximal sterile barrier precautions. This involves wearing a sterile gown, sterile gloves, a cap, and a mask, along with using a large sterile drape to cover the patient. This comprehensive sterile approach creates a clean field, reducing the risk of contamination during the procedure.
Antiseptic Skin Preparation
Cleaning the skin at the insertion site with an appropriate antiseptic solution is crucial. A solution containing at least 0.5% chlorhexidine with alcohol is used and allowed to dry completely before insertion. Chlorhexidine with alcohol is preferred for its effectiveness in reducing CLABSI risk.
Site Selection
The selection of the central line insertion site also influences infection risk. Healthcare providers carefully choose a site that balances the need for access with the lowest infection risk for the patient. For adult patients, sites like the subclavian vein are generally preferred over the femoral vein due to a lower risk of infection, especially for longer-term use.
Daily Review and Prompt Removal
Healthcare teams regularly assess the central line’s medical necessity. The line is removed as soon as possible, as reducing its time in place directly lowers infection risk.
Ongoing Care and Maintenance
Proper care and maintenance of the central line after insertion are continuous efforts. This includes meticulous dressing changes, ensuring the insertion site remains clean and dry. Additionally, healthcare providers disinfect catheter hubs and injection ports with an antiseptic before each use to prevent germs from entering the line.
How Patients and Families Can Help
While healthcare providers implement various measures to prevent CLABSIs, patients and their families also play a supportive role in ensuring safety. Awareness and communication contribute to a safer care environment.
Ask Questions
Patients and family members are encouraged to ask healthcare providers questions about their central line. This includes inquiring about the necessity of the line, how it is being cared for, and confirming that healthcare workers perform hand hygiene before touching the line or the patient. Such questions foster open communication and reinforce best practices.
Report Concerns
It is important to report any changes or concerns observed around the central line insertion site immediately. This includes signs such as redness, swelling, pain, warmth, or drainage. Prompt reporting allows healthcare staff to assess and address potential issues quickly.
Avoid Touching
Patients and family members should avoid touching the central line or its dressing. Understanding the purpose of the central line and discussing with the care team when it might be removed can also empower patients and families in their care journey.