Infectious Diseases II
IDSA definition: Defines catheter-related bloodstream infection minimally as bacteremia or
fungemia in a patient who has an intravascular device and:
More than 1 positive blood culture obtained from a peripheral vein. A definitive diagnosis
requires that the same organism or organisms grow from at least 1 percutaneous blood culture
and from the CVC tip or that 2 blood cultures, 1 from a catheter hub and 1 from a peripheral
vein, be positive for the same organism(s);
ii.
Clinical manifestations of infection (e.g., fever, chills, and/or hypotension); and
iii.
No apparent source for bloodstream infection other than the catheter.
In 2012, the National Healthcare Safety Network (NHSN) reported central line–associated
bloodstream infection (CLABSI) rates across adult critically ill patient populations of 0.8 to 3.4
episodes per 1000 central line–days. Aggregated national data from 2016 showed almost a 50%
decrease in CLABSI rates from 2008 (0.56-1.00 cases per 1000 central line–days). Although
specific rates vary between sites and populations, all central line types and locations of insertion
have an attributable risk of bloodstream infection.
Accounts for 14,000–28,000 deaths per year
Increases mean LOS by 7 days
| d. | CLABSI is considered a preventable complication. The NHSN, using CDC definitions, provides |
|---|
population-specific event rates for institution surveillance and performance benchmarks. CMS
no longer provides reimbursement to providers for the treatment of catheter-related bloodstream
infections.
Etiology
CLABSIs are usually monomicrobial. Pathogen prevalence is based on patient-specific risk factors
and underlying illness.
Common organisms responsible for CLABSIs include coagulase-negative staphylococci
(e.g., S epidermidis), S aureus, Candida spp, and enteric gram-negative bacilli (e.g., E coli,
Klebsiella spp, Enterobacter spp).
Risk factors for multidrug-resistant organisms include critical illness, femoral catheter placement,
immunosuppression, and previous antibiotic exposure.
| d. | Candida spp are more common in patients with the following risk factors: total parenteral nutrition, |
|---|
prolonged use of broad-spectrum antibiotics, hematologic malignancy, stem cell or solid-organ
transplantation, femoral catheterization, or colonization owing to Candida spp at several sites.
Risk factors
Patient factors: Diabetes, hypotension, male sex, neutropenia, parenteral nutrition, prolonged
hospitalization before catheter placement
Catheter-related factors: Heavy microbial colonization at insertion site, inadequate catheter care,
internal jugular or femoral vein placement site (compared with subclavian vein), prolonged duration
of venous catheterization, use of non-tunneled catheters
Prevention strategies
Updated recommendations for best practices in the prevention of CLABSI have been sponsored
by SHEA, IDSA, the Association for Professionals in Infection Control, the American Hospital
Association, and TJC. These updates include evidence-based recommendations categorized as
essential practices that should be adopted by all acute care hospitals, or additional approaches
that can be considered for use in locations and/or populations within hospitals when CLABSIs
are not controlled after implementation of essential practices (Infect Control Hosp Epidemiol.
2022;43(5):553-569).
Essential practices
| (a) | Minimize central venous line insertions and durations of insertion. |
|---|---|
| (b) | Provide comprehensive education to ensure competency for all involved with insertion, |
care, and maintenance of CVCs.