Central Line-Associated Bloodstream Infections

CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 7

CentralLine-Associated Bloodstream Infections

CentralLine-Associated Bloodstream Infections

CentralLine-Associated Bloodstream Infections (CLABSI), are bloodstreaminfections caused by entry of microbial pathogen into the bloodthrough the catheters used during the medical procedures of drawingblood or giving of fluids and medication. According to Watcher(2012), over 20,000 people in the United States die annually as aresult of CLABSI. At the same time, most CLABSI occur in the wardsand in the intensive care units in common health care facilities.Most of the CLABSI infections occur as blood infections associatedwith the use of the catheter during blood circulation and relatedprocedures. This discussion will explore the types of errorassociated with CLABSI, a review of the related literature and createa patient safety guideline that should be adopted to prevent theproblem.

Thetype of error

CLABSIinfections take place because of the entry of bacteria and diseasecausing pathogens into the bloodstream during the processes of usingcatheters in the blood. A central line is used in treatment byplacing it in the patient’s large vein of groin, neck, chest orarms (O’Grady,2011).The errors that lead to the infection take place when the bacteriaenter through the catheter and travels to the bloodstream. Theincident is high risk because it involves the very equipment orprocesses that are considered safe and used in day to day treatmentprocedures (O’Grady,2011).The infection by the disease causing pathogens causes illnesses thatrange in severity depending on the type of the pathogen and immunitylevels of the victim.

Oneof the multidisciplinary responsibilities for CLABSI is the physicianresponsibility to ensure that the process is free of external entryof pathogens via the catheter. The other responsibility is for thestaff to ensure the sterilization and cleanliness of the equipmentused. Both the physician and the staff should adhere to the rules,the procedures and preventive measures (Timmelet al, 2010). However, the main barrier that reduces the teamwork isthe lack of teamwork between the people responsible for theprocedural processes that prevent the occurrence of CLABSI (O’Grady,2011).The occurrence of CLABSI in a health care setting is mostly becauseof the lack of adherence to the safety measures. However, health careproviders have the resources like sterilization equipment and safety,cleaning tools for ensuring the prevention of the occurrence of theCLABSI.

LiteratureReview

Theoccurrence of CLABSI may lead to illnesses that may lead to death ifextreme and untreated appropriately. Peredoet al (2010),argues that CLABSI cases are fatal while others increase the level ofstay in the hospitals by the patients. The increase in the stay inthe hospital increases the cost of treatment for both the patient andthe hospital. Shahet al (2013) reports that increase in length of stay in hospital isbetween 10 to 20 days, which costs hospitals between $4000 and$56000. According to Stephen(2011), CLABSIcases are reported in around 3% of catheterization procedures.However, this statistic can be as high as 16% if the right measuresare not taken, and can be lower if proper procedures are adhered to(Stephen,2011).

Accordingto a research byShahet al (2013), the incidences around 33% of the incidences reported inthe united states occurred in the ICUs. This is because of the highlevel of catheterization procedures that take place in ICUs comparedto other places in a hospital setting. The risks of infection of theCLABSI are categorized into patient, catheter and operator factors.Patient factors include compromised skin integrity, granulocytopenia,presence of distant infection and the severity of illness(Shahet al, 2013). Catheter factors include the type of the catheter andtreatment of catheters (Shahet al, 2013). According to Timmelet al (2010), the coating of catheters with antimicrobial orantiseptic reduces infection. Moreover, risk factors relating tooperators include cleanliness, adherence to procedures and expertiseof the operators.

Thehistory of occurrence of CLABSI dates back to 1929 whenForssmann&nbspfirstintroduced the initial stages of centralvenous catheterization&nbsp(CVC)(Shahet al, 2013). Over the time, the use of intravasculardevices has reached to the level of over 150 million devices per yearin the United States only(Shahet al, 2013). Due to the increased use of the intravasculardevices, blood stream infections resulting from their use increased,which also elevated the cost implications.As a result of the increase in the CLABSI cases, and the implicationsof the resulting complications, the need for safety measures hassince been prioritized both in the United States and the world (Shahet al, 2013).

Tomanage the resultant situations, there are regulations that have beenset for health care providers and institutions that are related toCLABSI cases. One of the regulations is the cleanliness of the healthcare operators of the intravasculardevices and the staffs that are involved in the catheterizationprocedures(O’Grady,2011).Another regulation is the proper sterilization of the equipment usedin the catheterization procedure to avoid infection by the microbialpathogens (Timmelet al, 2010). This involves procedures that are laid for thephysicians and the staff that are involved in the catheterizationprocedures. In addition, regulations have been put to require thepatient cleaned before the catheterization procedure (Shahet al, 2013). For patients going home with the intravasculardevices, proper procedures should be communicated and taught to themby physicians responsible.

Inaddition, there are interdisciplinary and collaborative efforts thatare set to reduce potential causes of CLABSI to patients and promotesafety of patients. The interdisciplinary include the adherence tothe standard procedures that are set in an attempt to ensure thesafety of the procedures. In addition, the staff at the health careproviders should demonstrate knowledge of the risk factors in orderto avoid the materialization of the risk of CLABSI (Timmelet al, 2010). Collaborative efforts involve cooperation between thephysicians that carry the catheterization procedures and the nursingstaff at the health care facilities. All the staff members shouldcollaborate to ensure cleanliness of the intravasculardevicesand the equipment used (Timmelet al, 2010). They should also collaborate to control each other byensuring they all adhere to safety procedures. The collaboration inthe activities helps in the reduction of the risk factors andeventually the CLABSI that can be reported.

PatientSafety Action Plan

Accordingto Watcher (2012), the Keystone Project is a conceptual model for theprevention of the hospital related diseases such as the CLABSI andpromotion of patient safety. This model is an appropriate theoreticalmodel for preventing CLABSI. The use of the model is appropriatebecause it aims at preventing major hospital-related infections in acomprehensive manner and in all the sections of treatment (Pronovost,2010). Practiced in Michigan Hospital, the Keystone Project seeks theimplementation of safety measures through rigorous practices thatfocus on the effectiveness of measures taken. According to Pronovost(2010), the hospitals that participated in the Keystone Projectrecorded a significant reduction in the levels of catheter-relatedbloodstream infections and low or no cases of bloodstream infections.

Themodel sought to reduce the risk for cases of CLABSI and for theprevention of the infections (Pronovost, 2010). One of the mainaspects and outcomes for the risk reduction is the cleanliness of thephysicians and the staff. This is a key step of the patient safetyaction plan because it requires the medical workers to maintain highlevels of cleanliness in order to prevent the occurrence of CLABSI.In addition, proper treatment and disinfection of the catheter andother equipment is a necessary requirement of the action plan.

Aspart of the patient safety action plan, patients should be trained onthe basic requirements of cleanliness and its significance in theirsafety. This is one of the main learning needs that is necessary inorder for the plan to be successful in reducing the risks of CLABSI(Peredoet al, 2010).In addition, there are learning needs of the medical staff at thetreatment facilities. In this regard, physicians and assistant staffrequire adequate training on the safety plan and the risk factors forCLABSI.

Oneof the goals that will facilitate the plan implementation is thorougheducation. Both the medical staff and the patients require sufficienteducation on the risk factors for CLABSI and the prevention methods.Secondly, cleanliness of the equipment and catheters used in thetreatment processes is a significant goal for both the medical staffand the medical facility (Peredoet al, 2010).Thirdly, the goal for a quantitative reduction in CLABSI cases, orthe target is needed to give the medical staff the direction towardsthe prevention of the occurrence of the infections. Fourthly,monitoring patient progress is an important goal of ensuring reducedinfections and cleanliness. This and other goals will facilitate theimplementation of the safety plan.

References

Shah,H., Bosch, W., Thompson, K.M., &amp Hellinger,W.C. (2013). IntravascularCatheter-Related Bloodstream Infection. TheNeurohospitalist.2013 Jul 3(3): 144–151

Pronovost,P.J., Goeschel, C.A, &amp Colantuoni, E. et al. (2010). Sustainingreductions in catheter related bloodstream infections in Michiganintensive care units: observational study. BMJ&nbsp2010340:c309

Stephen,F. (2011). Catheter-relatedbloodstream infection. ContinEduc Anaesth Crit Care Pain&nbsp2005,&nbsp5&nbsp(2):&nbsp49-51

Timmel,J., Kent, P.S., &amp Holzmueller, C.G. etal.(2010). Impact of the Comprehensive Unit-Based Safety Program (CUSP)on Safety Culture in a Surgical Inpatient Unit. JointCommission Journal on Quality and Patient Safety,2010 36(6): 252-260

Peredo,R., Sabatier, C.,&nbspVillagrá,A., González, J., Hernández, C., Pérez, F., Suárez D., &ampVallés, J.(2010). Reduction in catheter-related bloodstream infections incritically ill patients through a multiple system intervention.EurJ Clin Microbiol Infect Dis,2010, Sep29 (9): 1173-7

O’Grady,N.P., Alexander, R., Burns, L.A., et al.&nbsp(2011).Guidelinesfor the prevention of intravascular catheter-related infections.&nbspAmJ Infect Control,201139(4suppl 1):S1–S34

Watcher,R. (2012). Understanding Patient Safety, Second Edition. New York:McGraw Hill Professional