CLABSIs: What Are They?
In our recent blog, we talked about the infections associated with catheters, which are part of a larger problem in the United States: hospital-acquired infections. According to the Centers for Disease Control and Prevention, at least one in 31 hospital patients has one or more HAIs at any given time. These diseases range from urinary tract infections to Clostridium difficile, and they are caused by unsanitary conditions.
Now, we will take a deep dive into a particular kind of catheter infection: a CLABSI, or a central line-associated blood infection. CLABSIs disproportionately impact patients who are already seriously weak. In the intensive care unit, an estimated 48% of patients are given indwelling central venous catheters or “central lines.”
The Agency for Healthcare Research and Quality’s toolkit states that 84,551 to 203,916 preventable infections show up every year, and an estimated 28,000 patients are killed by CLABSIs. What can medical providers be doing to change these numbers?
What Is a Central Line?
Called “central lines,” “indwelling venous catheters,” or simply, “central venous catheters” (CVC), central lines involve a thin tube that goes into a vein in your arm, neck, chest, or groin. It is a step up from an intravenous line, located closer to the heart for easier access and quicker delivery of fluids, blood, medications, or blood draws for tests.
- A peripherally inserted central catheter or PICC is placed in the arm.
- A tunneled catheter is placed in the neck or chest, coming out through the skin to provide entry for doctors to use.
- An implanted port is placed entirely under the skin, and doctors must use needles to access the port through the skin.
The central line may be left in for weeks, even for months, depending on the needs of the medical team. They are especially common in ICUs. These lines are given to patients who require dialysis, chemotherapy, or a great deal of medication or transfusions, which can damage the veins if continually delivered via IV. Some newborns are also fitted with central lines, especially in the NICU.
How Do Infections Occur?
The ease that central lines offer to medical professionals is offset by how common and how damaging the resulting infections can be. With a “highway” to the patient’s bloodstream, bacteria and viruses can quickly spread and grow. Doctors and nurses must follow strict procedures with inserting or removing the line, changing a dressing, or even checking a line. They must keep the line sterile.
Healthcare providers should be washing their hands; wearing a mask, cap, gown and sterile gloves before handling the area; cleaning the patient’s skin with antiseptic before inserting the catheter; choosing a vein with the lowest risk of infection (for instance, avoid the femoral vein in adult patients); and removing the catheter as soon as possible. They should be alert to any signs of redness, swelling, or fever in the patient. And they should take urgent steps to prevent sepsis.
Sepsis is what happens when an infection that has spread to more than one section of your body. The chemicals released in your blood cause widespread inflammation and septic shock – when your blood pressure drops, and your lungs, kidneys, and liver begin to fail. This is a medical emergency that must be treated immediately.
What Should You Do After Surviving a Hospital Infection?
The Centers for Disease Control and Prevention, together with other organizations, have guidelines to prevent CLABSIs. AHRQ, for instance, offers evidence-based practices to hospitals that have reduced CLABSI rates by 41% when implemented – closer to 100% when implemented with another program. We ask, why aren’t these clinical practices being put into place in every hospital? Until they are – until CLABSIs are eradicated – our trial lawyers will continue to fight back.
Resources:
AHRQ: Central Line-Associated Bloodstream Infections
CDC: Central Line-Associated Bloodstream Infection
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