Safety is in the details
Safety in the ICU
CLABSI prevention

CLABSI prevention challenges

December 18, 2017

 

The importance of CLABSI prevention guidelines


Central line-associated bloodstream infections (CLABSIs) are a major safety concern for both clinicians and patients. Majority of CLABSIs are related with the use of central venous catheters (CVC) and are in fact one of the most important complication in critical care.


It is estimated that as many as 250,000 blood stream infections occur annually, most of which are associated with the presence of intravascular devices. The CLABSI rate in American intensive care units (ICU) is projected to be 0.8 per 1000 central line days, while the International Nosocomial Infection Control Consortium (INICC) reported a CLABSI rate of 4.1 per 1000 central line days, following data surveillance of 703 intensive care units in 50 countries between January 2010 and December 2015. Of all healthcare associated infections (HAIs), CLABSIs are the most costly, accounting for an estimated $46,000 per case.


Considering the high rates of morbidity, mortality, lengthened hospital stay as well as the costs associated with these infections, CLABSI prevention guidelines provided to the healthcare community for the insertion and maintenance of central lines should be strictly adhered to, in an effort to curtail these incidences.


However, despite the fact that evidence based clinical practice guidelines for the prevention of CLASBI have recommended multiple strategies to lower CLABSI rates, it is evident that these infections remain a major cause of mortality and morbidity among patients with a central line in situ worldwide.


Poor adherence to prevention guidelines - a major cause for CLABSI prevalence


In order to assess compliance with CLABSI prevention guidelines, researchers documented attitudes and practices in intensive care units (ICUs) between June and October 2015. Medical doctors and nurses working in ICUs worldwide completed an online questionnaire designed to investigate central line insertion and maintenance practices as well as measurement of CLABSI.


Responses from 14 middle income and 27 high income countries were analyzed and revealed that the availability of written clinical guidelines for CLABSI prevention was up to 80 percent for middle income countries while it was 81 percent for high income countries. It was further found that the rate of compliance with a bundle of recommended central line insertion practices was at 23 percent of middle income countries and 60 percent of high income countries. The survey revealed that 60 percent of middle income countries and 73 percent of high income countries had a daily assessment of central line necessity.


Researchers concluded from this study that although there is clear awareness and interest in the ICU community for CLABSI prevention in high and middle income countries, implementation and adherence to those existing guidelines during insertion and maintenance of central lines need to be reinforced. The researchers have further identified areas for improvement in clinical and measurement practices related to CLABSI prevention in ICUs.

 

Factors contributing to poor adherence of CLABSI prevention guidelines


Lack of time or resource constraints, lack of proper information or necessary skill sets are critical factors that contribute to the compromised adherence to full prevention procedures. In a study published in the American Journal of Infection Control in 2014, comparing perspectives of infection control professionals and frontline staff, it was noted that some of the main challenges in CLABSI prevention guideline adherence in ICU settings was a lack of adequate time and a difficulty in the acquisition of education and skills to enable frontline staff to effectively apply and adhere to the CLABSI prevention guidelines as set out by the relevant bodies. 


As per the study, both infection control professionals (ICPs) and frontline ICU clinicians, especially nurses, unanimously contend that competing priorities often make it difficult to ensure that all recommended prevention procedures are adhered to.

 

Catheter maintenance procedures contributing to CLABSIs 

 

Flushing a catheter is strongly recommended to ensure it remains well-functioning. Flushing techniques, fluid dynamics, and ample flushing volumes are vital aspects in adequate flushing in all types of catheters. Adequate flushing of catheters may also wash out all possible nesting material for microorganisms, thereby reducing the risks of catheter-related bloodstream infections.

 

The catheter site and the hub are the main sources of bacteria (and fungi) that lead to catheter colonization and resulting CLABSIs. These microorganisms may be introduced when the catheter is manipulated, and when poor flushing techniques are used.


A larger port reservoir, or “dead space” typically creates an environment for the accumulation of debris and fibrin deposits, which in turn, create an environment for microbial colonization. This phenomenon is yet another great potential for the development of a CLABSI. An ample flush volume is necessary to enable the effective removal of debris and fibrin deposits within the catheter and the port reservoir.  Taking into account the fact that time and skills are evidently already lacking for clinicians in ICU settings, it may become difficult to adhere to and effectively carry out those procedures involving flushing and maintenance of catheters correctly and in accordance with CLABSI prevention guidelines.


How can MarvelousTM stopcocks help prevent CLABSIs


The MarvelousTM stopcock was designed with optimal convenience and safety for both patients and clinicians in mind.  The innovative MarvelousTM stopcock can help prevent CLABSI because it comes with a continuous-flush feature, minimal “dead space” and a luer-activated valve (LAV) that serves as a bacterial barrier, allowing access to the line without opening it.

 

The continuous-flush feature of MarvelousTM stopcocks means that not only is a clean catheter maintained at all times, but that catheter manipulation is greatly decreased and thus, the chances of microbial transfer is reduced and therewith, the chances of CLABSI contraction.


Minimal “dead space” in a CVC is ideal due to the fact that it leaves less environment for residual accumulation. Given the fact that “dead space” residue is a CLABSI hazard, the MarvelousTM stopcock, with optimal safety as a priority, is designed with minimal “dead space” that ensures minimal residual accumulation.


These features of MarvelousTM stopcocks may not only help in the prevention of CLABSIs directly, but also indirectly by compensating for the time and skills needed to maintain CVC lines in the ICU in good accordance with the recommended CLABSI prevention guidelines. Check out how much you can save with MarvelousTM 


The benefits of preventing CLABSIs


Taking active measures towards Zero-CLABSI rates is highly beneficial.  Zero-CLABSI rates ensure a much shorter and safer hospital stay for patients as well as much speedier recovery. Furthermore, a Zero-CLABSI rate ensures that the pressure for clinicians working in critical care setting is reduced.

 

References
Haddadin Y, Regunath H. Central Line Associated Blood Stream Infections (CLABSI) [Updated 2017 Mar 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430891/
https://www.ncbi.nlm.nih.gov/pubmed/25239713
https://www.ncbi.nlm.nih.gov/pubmed/23182523
https://insights.ovid.com/pubmed?pmid=22561118
https://insights.ovid.com/pubmed?pmid=27895904&isFromRelatedArticle=Y
https://insights.ovid.com/pubmed?pmid=27152193&isFromRelatedArticle=Y
https://insights.ovid.com/pubmed?pmid=27031355&isFromRelatedArticle=Y
https://www.cdc.gov/hai/bsi/bsi.html
https://www.beckershospitalreview.com/quality/cdc-investments-in-clabsi-prevention-produce-substantial-benefits.html

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