Central line associated bloodstream infections

1. By
Dr.Nagu Penakacherla MBBS, MEd(USA),
DNB(Family Medicine)
Central Line-Associated
Bloodstream
Infection (CLABSI) Prevention
The Central Line Bundle and YOU!

2. Central Line or Central Vascular
Catheter
• Intravascular catheter that terminates at or close to the
heart or one of the great vessels
• Nontunneled CVCs (subclavian, jugular)
• Tunneled CVCs (Broviac, Hickman, Groshong)
• Dialysis catheter (Quinton)
• Peripherally inserted central catheters (PICCs)
• Implanted ports (Permacath)
• Used increasingly to provide long-term venous access in
all care settings, including outpatient
• Note: midline catheters are not in this category

3. Pathogenesis of CLABSI
More Common Mechanisms
• Extraluminal: Pathogens migrate along external surface
of catheter
- More common in early period following insertion, < 7 days
• Intraluminal: Hub contamination, migration along
internal surface
• - More common >7 days, intraluminal colonization
Less Common Mechanisms
• Hematogenous seeding from another source
• Contaminated infusates

4. Biofilms
• Complex aggregation of microorganisms
growing on a solid substrate
• Form on catheter surfaces
• Contribute to risk for CLABSI

5. CLABSI Risk Factors
• Multiple catheters and/or multiple lns
• Emergency insertion
• Prolonged duration of CVC
• Prolonged hospital stay prior to CVC insertion
• Excessive manipulation of the catheter
• Neutropenia
• Prematurity
• Total parenteral nutrition

7. How Can We IMPACT Central Line
Associated Blood Stream Infections
(CLABSIs)?
• What is the Central Line Bundle?
Includes the following bundle of 5 care
components:
1. Hand hygiene
2. Maximal barrier precautions
3. Chlorhexidine skin antisepsis
4. Optimal catheter site selection
5. Daily review for line necessity and
assessment with prompt removal of
unnecessary lines

8. HAND HYGIENE – Just do it!
• Before and after palpating catheter insertion sites
• Before and after inserting, replacing, accessing,
repairing, or dressing a catheter
• When hands obviously soiled or contamination
suspected
• Before and after invasive procedures
• Between patients
• Before donning and after removing gloves

9. MAXIMAL BARRIER PRECAUTIONS
Use strict adherence as the inserter and all involved
with the placement of a central line or guidewire
exchange with the following:
• Compliance with hand hygiene
• Wear cap, mask, sterile gown and sterile gloves
• Cap – covers all hair
• Mask – covers nose and mouth tightly
• Sterile drape – covers patient from head to toe
with a small opening for line placement

10. CHLORHEXIDINE SKIN PREP
• Chlorhexidine (CHG) skin prep prior to
placement and for dressing change.
• PINCH wings on CHG applicator.
• PRESS sponge against the skin allowing the
solution to penetrate the pad.
• PREP covering a large area using a back and
forth, up and down, and diagonal friction
scrub for at least 30 seconds. Allow to dry. Do
not wipe, blot or fan.

11. OPTIMAL CATHETER SITE SELECTION
Subclavian vein is the preferred site for non-tunneled catheters and
is associated with lower risk of CLABSIs rather than the jugular
vein.
-Femoral site is associated with greater risk of infection and DVTs in
adults.
University and International Hospitals preferred sites:
• Subclavian and Internal jugular are preferred sites.
• Femoral site would be an option for:
1. ECMO
2. Neuroprotective hypothermia-thermaguard
3. Other insertion sites are not able to be accessed due to poor
vascular upper extremities, etc.
4. A need for dialysis or other patient emergencies

12. DAILY LINE ASSESSMENT AND REVIEW
• The risk of CLABSIs increases over time.
• Complete daily assessment of central line for infection.
• Prompt removal of unnecessary lines.
• The replacement of temporary catheters in the presence of
bacteremia is not an acceptable replacement strategy. The
source of infection is usually colonization of skin tract from
the insertion site to the vein.
Roles in Daily Site Assessments:
• Physicians should assess and document daily the criteria for
the patient to maintain a central line.
– For example: “R internal jugular CVC- clear, dry, intact, no erythema
noted. Still necessary for IV access on pressors, etc.”
• Should be discussed during daily attending rounds.

13. Empower nurses and others to
“STOP THE LINE”
if any of bundle components are
missing

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CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION FROM
MARCH 2014- MARCH 2015
FBG
INICC
NHSN
INTERNAL
BENCHMARK B.G
Road