CENTRAL LINE-ASSOCIATED

BLOOD STREAM
INFECTIONS (CLABSI)
BY: HILLARY, ROSE, SEAN, MARIE

SUMMARY
WHAT IS CLABSI?

RISK FACTORS:

A CENTRAL LINE-ASSOCIATED BLOODSTREAM

INFECTION (CLABSI) OCCURS WHEN BACTERIA
ENTERS THE BLOODSTREAM THROUGH A CENTRAL
LINE CATHETER.

HAVING A CATHETER FOR A LONG TIME

IF BACTERIA START TO GROW ON THE CENTRAL LINE

CATHETER, THEY CAN EASILY ENTER THE BLOOD AND
CAUSE A SERIOUS INFECTION. THIS CAN LEAD TO A
CONDITION CALLED SEPSIS, WHICH OCCURS WHEN
BACTERIA OVERWHELM THE BODY.

HAVING A CATHETER THAT IS NOT COATED WITH AN

ANTIMICROBIALA SUBSTANCE THAT KILLS
BACTERIA
HAVING A CATHETER INSERTED INTO A VEIN IN THE
THIGH
HAVING A WEAKENED IMMUNE SYSTEM
BEING IN THE INTENSIVE CARE UNIT

CAUSES - BACTERIA NORMALLY LIVE ON THE SKIN.

THESE BACTERIA WILL SOMETIMES TRACK ALONG THE
OUTSIDE OF THE CATHETER. FROM THE CATHETER,
THEY CAN GET INTO THE BLOODSTREAM.

HAVING AN INFECTION ELSEWHERE IN THE BODY OR

SKIN

SYMPTOMS - FEVER; CHILLS; INCREASED HR;

REDNESS, SWELLING, OR TENDERNESS AT THE
CATHETER SITE; DRAINAGE FROM CATHETER SITE

ANTIBIOTICSTYPE DEPENDS ON WHICH BACTERIA

IS FOUND IN YOUR BLOOD.

TREATMENT OPTIONS:

CENTRAL LINE CAREOFTEN, THE CENTRAL LINE

CATHETER WILL NEED TO BE REMOVED AND
REPLACED BY A NEW CATHETER

SUMMARY (CONT)
PROCESSES OF THE ISSUE

KEY PLAYERS INVOLVED IN THE

PROCESS

CENTRAL LINE INSERTION

DOCTOR/IV TEAM

CARE OF CENTRAL LINE AFTER

PLACEMENT

REGISTERED NURSE
PATIENT

REMOVAL OF CENTRAL LINE

COMPARISON TO NATIONAL INDICATORS

CLABSI INCIDENCE STATISTICS: 250,000 CASES PER YEAR
HERE ARE SOME NATIONAL ESTIMATES RELATED TO CLABSI:
15 MILLION CENTRAL-VASCULAR-CATHETER DAYS IN INTENSIVE CARE UNITS
NATIONALLY
250,000 CLABSI CASES IN HOSPITALS, OF WHICH 80,000 OCCUR IN THE ICU
58 PERCENT DECREASE IN CLABSIS IN ICU PATIENTS COMPARING 2001 AND 2009
3,000 TO 6,000 LIVES SAVED IN 2009 COMPARED TO 2001 DUE TO THIS DECREASE
$414 MILLION MEDICAL COST SAVINGS IN 2009 COMPARED TO 2001 DUE TO THIS
DECREASE

SOURCE: BLOODSTREAM INFECTIONS: HOSPITALS MAY BE WINNING THE FIGHT, BUT THERES MORE WORK TO DO. THE JOURNAL OF HEALTHCARE CONTRACTING;9(4):48, 50-53, 56, AUG. 2012.
CLICK HERE TO LINK TO PUBLISHERS WEBSITE: HTTP://WWW.JHCONLINE.COM/BLOODSTREAM-INFECTIONS.HTML POSTED BY AHA RESOURCE CENTER, (312) 422-2050, RC@AHA.ORG

http://www.ahrq.gov/professionals/quality-patient-safety/cusp/onthecusprpt/onthecusp.pdf

TO PREVENT OR REDUCE THE RISK

Hand Hygiene
Do not use artificial nail when working in the healthcare
facility.
Decontaminate hands with alcohol-based hand cleaner; if
hands are visibly contaminated with blood or body fluids, use
antimicrobial soap and water.
Use hospital-provided hand lotions compatible with
antiseptic agents to maintain integrity of skin. Home lotions
may neutralize antibacterial agents in antiseptic agents used
in hospitals.
Decontaminate hands before and after putting on or removing
gloves, providing direct client care, assisting with insertion of
central venous catheter, changing central venous dressing, or
accessing catheter to administer medication or flush.

Barrier Precaution
Keep all supplies together on nursing unit to prevent need
to look for additional supplies after CVC insertion is begun.
Use maximum barrier precautions when inserting or
assisting with insertion of central venous catheters,
including PICC lines. Include: cap that covers all hair,
mask covering mouth and nose, sterile gown, and sterile
gloves.
Cover client from head to toe with large sterile drape
leaving small opening for opening for insertion of catheter.
Place mask on client when PICC insertion is done, and
cover face if subclavian or jugular vein placement site for
central venous catheters.

Daily Assessment
Evaluate need to determine when lines are no longer necessary and should be
removed.
Provide site care when needed and according to facility policy.

TO PREVENT OR REDUCE THE RISK (CONTD)

Catheter Site Selection
Use central venous catheters (CVCs)
impregnated with antimicrobial agents, if available.
Nontunneled percutaneously inserted CVCs
are available with three different agents;
chlorhexidine/silver sulfadiazing;
rifampin/minocycline; and silver/platinum
ionic metals. PICC brand uses
rifampin/minocycline agents.
Catheter should be inserted in the subclavian
vein for nontunneled catheter.
These catheters should be used for clients with
dwell time of more than 5 days and in healthcare
facilities where catheter-related bloodstream
infection rates are high.

Site Preparation Using Chlorhexidine Gluconate

Prepare site using 2% Chlorhexidine
Gluconate
Pinch wings on chlorhexidine applicator to
break open ampule. Hold applicator down
to allow solution to saturate pad.
Press sponge against skin.
Swab with applicator using a vigorous backand-forth motion. This motion creates
friction and lets solution more effectively
penetrate epidermal layers.
Swab site for 30 seconds and then allow to
dry thoroughly, approximately 2 minutes.
Do not wipe or blot area.

EVIDENCED BASED RESOURCES

CLABSI Prevention in the Aloha State
This article briefly talks about the control measures and tools that hospitals in Hawaii have
used between 2009 and 2012 and greatly reduced their infection rates. This also included a
link to a helpful video titled The Dirty Dozen (http://ow.ly/m66WB) which was created in 2012
by the Hawaii CUSP-STOP BSI collaborative to compare and contrast the techniques that help
prevent CLABSIs vs. those that leave a patient prone to CLABSIs.
Source: CLABSI prevention in the Aloha state. (2013). Hospital Infection Control & Prevention, 404.

Reduction in Central Line-Associated Bloodstream Infections by Implementation of a Postinsertion

Care Bundle
This research article discusses how a central line care bundle (which includes steps from our
QI tools) helps to drastically reduce the incidences of CLABSIs.
Source: Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central line-associated bloodstream infections by implementation
of a postinsertion care bundle. American Journal Of Infection Control, 38(6), 430-433. doi:10.1016/j.ajic.2010.03.007

Central Line Infections Fall in ICUs

This article explains how there has been a 60 % decrease in CLABSIs between 2001 and 2009
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by implementing preventive measures, which includes, but isnt limited to, our QI tools.
Source: Traynor, K. (2011). Central line infections fall in ICUs. American Journal Of Health-System Pharmacy, 68(8), 650-652.
doi:10.2146/news110023

QI TOOLS & HOW TO EVALUATE

SURVEILLANCE THROUGH PROPER

DOCUMENTATION (WRITTEN/ELECTRONIC)
REPORT INCIDENTS ACCORDINGLY
DATE & TIME, PROCEDURE (FLUIDS, MEDS),
TOLERATION
NOTE SIGNIFICANT CHANGES - S/S OF INFECTION
(FEVER, CHILLS, REDNESS AND PAIN AT SITE,
POSITIVE BLOOD CULTURE)
REPORT ADHERENCE TO PREVENTATIVE
MEASURE
PUBLIC REPORTING (EXAMPLE ON LEFT)

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The Joint Commission. Preventing Central LineAssociated Bloodstream Infections: Useful Tools, An
International Perspective. Nov 20, 2013. Accessed [user please fill in access date].
http://www.jointcommission.org/CLABSIToolkit

Q&A

What is CLABSI?

Name 3 symptoms that might appear with CLABSI

What is the treatment option?

Aside from hand washing, name another way of

protecting the patient when dealing with a Central
line.

RESOURCES
Bloodstream infections: Hospitals may be winning the flight, but theres more work to
do. The Journal of Healthcare Contracting;9(4):48, 50-53, 56, AUG. 2012. Http: //
www.jhcoonline.com/bloodstream-infections.html. Posted by AHA Resouce Center, (312)
422-2050, RC@AHA.ORG
CLABSI prevention in the Aloha state. (2013). Hospital Infection Control & Prevention,
404.
Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central lineassociated bloodstream infections by implementation of a postinsertion care bundle.
American Journal Of Infection Control, 38(6), 430-433. doi:10.1016/j.ajic.2010.03.007
The Joint Commission. Preventing Central LineAssociated Bloodstream Infections:
Useful Tools, An International Perspective. Nov 20, 2013. Accessed [user please fill in
access date]. http://www.jointcommission.org/CLABSIToolkit
Traynor, K. (2011). Central line infections fall in ICUs. American Journal Of HealthSystem Pharmacy, 68(8), 650-652. doi:10.2146/news110023

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