CLABSI: An Ounce of Prevention
By Eddie Korycka, MSN, RN
The rise of dangerous Central Line Associated Blood Stream Infections (CLABSI) should spur a review of your hospital’s vascular access program. Here are some basic strategies to diminish the risk.
In this second installment on complications, we will examine how central line insertion, care and maintenance practices can reduce instances of CLABSI. This is vital as over 5 million central venous catheters are placed a year, making CLABSI an ever-present concern for healthcare institutions. It’s also a good time to revisit your program as there was a 47% increase in CLABSIs in 2021 and 774 hospitals faced CLABSI-related penalties that same year.
Adherence to a Bundle
Care bundles are a set of interventions that can be used to improve patient outcomes. A 2021 reportoutlined an ICU’s use of this strategy to reduce CLABSI from 3.1 to 0.4 per 1000 catheter days. Assessing your staff’s knowledge of the bundle through unit-based observations and surveys is a good way to obtain a baseline, which can then be used to improve adherence over time.
Placement is Critical
Performing a central line insertion requires expertise and placement is key. The catheter placement impacts how intact the dressing remains (non-intact dressings have been shown to increase infection rates by 2.5 times).
For example, lower placement of a central line allows the catheter to be directed towards the chest, where it can more effectively be dressed and maintained. Fortunately, ultrasound technology has made this placement less risky and is now recommended to help locate catheters lower on the jugular and away from the ear and hairline.
Practice Makes Perfect
Changing dressings properly is a skill, one that can lead to reduced infections. For example, migration of a line when a clinician attempts to push the catheter back in can lead to infection.
Understanding and practicing the correct use of skin antiseptic, securement devices and dressings will help keep dressings on longer. Practice or coaching for inexperienced clinicians is a critical best practice that can help mitigate this risk. Precepting also ensures clinicians have comfortable and confident approaches to changing dressings.
Materials Choice
The catheter material itself can make a difference, working in the background to protect your patient. Consider new materials like those that mimic the body’s natural chemistry to discourage the formation of thrombus on a catheter which has demonstrated to increase catheter sepsis rates by 2X.
Re-evaluating your CLABSI prevention efforts is an investment that can produce safer patients, more competent staff, and overall gains in system-level efficiency with fewer penalties. By assessing your baseline efforts, implementing bundling and other best practices, then scaling education and management systems across your institutions, you can find clearer skies ahead.
