Central Line Associated Blood Stream Infections - Essay Example

Central Line Associated Blood Stream Infections (CLABSI) Proper hygiene is important in the healthcare industry and as a personal responsibility. Poor hygiene is attributed to various infections ranging from cholera to typhoid. CLABSI is an example of an infection caused by poor hygiene during surgical operations. The USA’s CDC (Centers for Disease) categorizes CLABSI as a Healthcare Associated Infection (HAI). The disease is widespread as there more than 1.7 million patients infected with HAIs such as CLABSI in the United States (Dutcher, 2013). Of all the HAIs contracted in healthcare institutions, CLABSI is the most common. This is because more than half of the patients in the Intensive Care Unit (ICU) require a central line during their stay. As mentioned earlier, HAIs are infections that patients develop during their time in healthcare institutions. HAIs are prevalent worldwide affecting hundreds of millions every year. These infections increase the morbidity and mortality rates of individuals in developing and developed countries (Soule & Memish, 2007). The most vulnerable are patients in the ICU due to the complicated medical operations. Critically ill patients undergo invasive medical that increases their immune-compromised state and antimicrobial resistance. Despite the stark reality and complications associated with Health-care Associated Infections, there are various ways to prevent and counter them. The main cause of CLABSIs in patients is the presence of Central Venous Catheters (CVCs). Critically ill patients and those requiring hemodialysis often use these catheters. These forms of catheters were in use as early as 1920 for the right ventricle. In the early days, the use of CVCs encountered problems such as catheter leaks, air embolism and hub separations (Dutcher, 2013). The occurrence of CLABSIs in patients became apparent later on. There were several risk factors that made patients vulnerable to CLABSI: intrinsic and extrinsic factors. Other than these factors, the factor with the greatest overall risk is the insertion and post-insertion maintenance of catheters. Intrinsic factors include age, underlying diseases and gender. Extrinsic factors, on the other hand, include prolonged hospitalization, multiple CVCs, parenteral nutrition, multilumen CVCs among others. Catheter removal is the most common diagnostic tool of confirming CRBSI in patients. The calculation of differential time to positivity (DTP) of blood cultures is another alternative method of diagnosing CLABSI (Cohn & Dolich, 2013). One of the most common causes of CLABSI is the presence of normal skin flora as blood culture contaminants in catheter. For this reason, to definitively diagnose CLABSI one requires multiple positive blood cultures to check the existence of the contaminants (Dutcher, 2013). Physicians require multiple cultures as this reduces the possibility of contaminants altering the cultures during the inoculation. According to Cohn and Dolich, if the physicians do not prescribe antibiotics prior to the collection of positive blood cultures then it is correct to presume that the patient has CLABSI (2013). Such presumptive diagnosis leads to the patient undergoing unnecessary treatments for CLABSI. Doctors and nurses ought to collect peripheral blood of their patients before antibiotics are administered. Despite the importance of collecting peripheral blood, most doctors avoid this deeming the procedure unnecessary. The collection of peripheral blood aids in the management of the patient’s condition and contraction of CLABSIs (Dutcher, 2013). A positive diagnosis of CLABSI indicates that the physicians should collect the patient’s blood cultures daily until they are negative. Once the lumens of the catheter are clinically stable, the doctors should cease collecting peripheral cultures. CLABSI has several distinguishing symptoms such as swelling, pain and swelling at the catheter site (Soule & Memish, 2007). The patient might also feel tenderness or pain along the catheter’s path. Other symptoms that are often overlooked are the patient experiencing sudden fever and chills without any prior infection. Healthcare professionals to diagnose CLABSI could also use these symptoms. Prevention of CLABSI involves a contributive effort from both the healthcare provider and the patient (Cohn & Dolich, 2013). On the healthcare provider’s part, they should practice hygienic and proper hand sanitization techniques while touching the central line. Prior to touching the central line, they should clean their hands with an alcohol-based agent or simply soap and water. The hygiene also extends to the technique used in placing the central line as they should wear masks, gloves and other protective gear. In short, during the placing of the catheter the healthcare providers should be covered from head to toe. They should also clean their skin using clorhexidine prior to placing the central line on the patient. Other standard procedures include constantly checking the central line for infections, changing the bandages once they are loose, damp or dirty (Soule & Memish, 2007). Prior to placing anything on the central line, the line’s hub should be scrubbed with alcohol or clorhexidine. The patients and their visitors also have a responsibility in preventing CLABSI as well. They should not contaminate the patient’s central line by touching, dressing the skin around the line or dirtying the dressing (Dutcher, 2013). The use of the sterile technique while accessing a port-a-cath also reduces the risk of CLABSI infections. The ports on the catheter usually have an infection rate approximately 2 percent as the nurse inserts a needle into the septum attached to the catheter (Soule & Memish, 2007). The sterile procedure reduces pocket and tunnel infections around the central lines. A mask is not necessary, but they are important if the nurse is accessing the non-coring needle after every 7 days. PAC and PICC are both central venous access systems that aid in the administering of IV treatments such as chemotherapy. Both make the administering of treatments less cumbersome as smaller veins are difficult to locate once treatment commences (Dutcher, 2013). Port-a-cath (PAC) is a surgically implanted catheter that is placed near the clavicle. The patients are able to feel the PAC underneath their skin as the catheter does not extend outside the skin. One can continue with their daily activities while using the PAC without infecting the site. PICC, on the hand is not, surgically implanted, and it extends outside the skin. The PICC, unlike the PAC, is administered on the upper arm. With the PICC, a patient’s activities are more restricted to avoid infections on the site. In conclusion, the PICC requires more maintenance than its PAC counterpart does. In conclusion, despite the various measures used in reducing the risk of CLABSI infections; they remain a burden in the medical community. The chance of recurrence of CLABSI infections is high due to the difficulty in managing and eradicating intra-luminal biofilm (Soule & Memish, 2007). For this reason, there is no optimal management procedure for CLABSI. However, the maintenance of a culture of safety and hygiene is likely to reduce the occurrence of CLABSI among patients. High-risk procedures such as accessing a port-a-cath should be under safe and hygienic conditions. CVC insertions and maintenance procedures should be strictly observed and upheld by the healthcare practitioners dealing with patients. References Cohn, S., & Dolich, M. (2013). Complications in Surgery and Trauma, Second Edition. Hoboken: Taylor and Francis. Dutcher, K. (2013). Can the central line-associated blood stream infection (CLABSI) definition be refined to include primarily those infections relevant to infection control practices?. [San Diego, Calif.]: San Diego State University. Soule, B., & Memish, Z. (2007). Best practices in infection control. Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations. Read More