Central Line-Associated Bloodstream Infection
Central Line-Associated Bloodstream Infection (CLABSIs) in a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter (CVC), refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). Central Line-Associated Bloodstream Infection is one of the leading causes of deaths each year in different countries across the globe. Central Line-Associated Bloodstream Infection has been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. The paper is an analysis of articles related to CLABSIs with the significant themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. 200 articles were established to talk about the CVCs, CLABSIs, risk factors, intervention, and benefits of preventive measures. Through inclusion and exclusion criteria many journal articles were left out because of being written in other languages rather than English. Therefore, the use of the English language index the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was used to search related journal articles. Other search tools include The National Center for Biotechnology Information (NCBI) – PubMed. Studies older than five years were excluded to ensure that the research remained current and up to date. Using real-time cases or conditions helps to improve the quality and validity of the resulted studies.
Questions Posed in the Studies
Afonso, Blot, & Blot (2016) seeks to establish how hospital-acquired bloodstream infections can be prevented through the use of chlorhexidine gluconate-impregnated washcloth bathing in intensive care units. In the study by Chidambaram (2015), the question raised is, what associations dental procedure, oral hygiene, and CVCs exist? Therefore, it is significant to question the role of proper hygiene in the care for patients with CVC
Education, Simulated Training, Experience, and Knowledge
Kadium (2015) inquired into how the education program for one month, based on the evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care? Other researchers that focus on how education, experience, and workshops enhance prevention or reduction of CVC infections include; El-Sol & Badawy, (2017), Leistner, Thürnagel, Schwab, Gastmeier, & Geffers (2016), and Soffle, Hayes, & Smith (2018). Dougherty (2015) questions the potential solutions in reducing incidences of central-line associated bloodstream infections have to be created in line with the clinical setting and careful consideration of the patients and the organizational culture. Education, simulated training, experience, and knowledge are critical aspects in the management of CLABSI infections.
Xu, & Wu, (2017), Commonwealth of Australia, (2015), Kadium, (2015), Morrison, Raffaele, & Brennaman, (2016), Tomar, Lodha, Das, Sood, Kapil, (2016), Lin, Apisarnthanarak, Jaggi, Harrington, Morikane, Thu, Ching, Villanueva, Zong, Jeong, & Lee (2015), and Esposito, Guillari & Angelillo (2017) concur with O’Grady, Alexander, Burns, Delilnger, Garland, Heard, Lipsett, Masur, Mermel, Pearson, Raad, Randolph, Rupp, & Saint (2015), the inquiry focused on how Positive blood culture shows the relationship between CLABSI and CDC surveillance. It is essential to establish the role of monitoring and appropriate inspection of the CVC site in studies regarding CLABSI.
Other researchers inquire into the CLABSI-related preventive measures implemented among adult patients hospitalized in an ICU. Such studies are by people like Perin, Erdmann, Higashi, Sasso, Bianco, et al. (2016), Jones, Forsyth, Jenewein, Ray, DiMarco, Pugh (2017), Masse, Edmond, & Diekema (2018), Oliveira, Stipp, Silva, Frederico, & Duarte (2016). In research by Basinger, (2015), the research question questions into the causal effects of the Comprehensive Unit-based Safety Programs (CUSP) on the reduction of CLABSIs within the relationship CUSP team member webinar attendance has with the decrease in CLASBIs. Other questions were on how knowledge and education of the family and patient could help in the prevention of CLABSIs attack. Among such studies are Kadium, (2015) and Powell (2018). Preventive measures are a core motive as to why the studies in CVC and CLABSI are conducted.
Other studies focused on how evidence-based practice, insertion, and maintenance of CVC could protect the patients from CLABSIs. Such research was done by Bianco, Coscarelli, Nobile, Pileggi, & Pavia (2014), World Health Organization (WHO, 2018) and Xu & Wu (2017). Perin, Erdmann, Higashi, & Sasso, (2016)., Perin, Erdmann, Higashi, & Sasso, (2016), Tomilnson (2015). Undeniably, in medicine, the establishment of evidence-based practice brings forth an improvement in the quality of CVC care.
Taveira, Lima, Araújo, & Mello, (2016), Tomar, Lodha, Das, Sood, Kapil, (2016), Pepin, Thom, Sorkin, Leekha, Masnick, Peras, Pineleas, & Harris, (2015), Morrison, Raffaele & Brennaman, (2016) question the risk factors of CLABSI
Impact of Intervention
On the evidence-based impact of fighting CLABSI, there is an evaluation by Baldassarre, Finkelston, Decker, Lewis, & Niesley, (2015), and Scott II, Sinkowitz-Cochran, Wise, Baggs, & Goates, (2016).
Then there is Han, Liang, & Marschall, (2015), who question how the involvement of education to the family and the patient can help prevent CLABSIs attacks among patients on CVC care. Another study by Yazan & Regunath (2018) examines the relationships between Positive blood culture and CLABSI. As such, as one types of research intervention practices for CLABSI, the question of its significance is imperative.
From this, various subthemes emerge in this study. These include; Hygiene and impact of this on the CVC situation. Most studies show that the more hygiene is considered and practiced, the lower the cases of CLABSI. Another concept is the knowledge that is necessary among nurses and patients handling CVC. Thorough understanding of the care for CVC improves and infections reduce. There are Policies which enhance the correct application of knowledge and maintenance of hygiene in the healthcare setting, hence decreasing incidence of infections.
Moreover, nurse experience is an essential subtopic due to evidence that supports that with higher experience in the CVC units; nurses tend to adhere and follow protocols and precautions which help prevent infections. Finally, there are Evidence-Based Practices/Interventions such as proper fitting, disinfection and sterilization, insertion bundle, maintenance bundle, and quality improvement.
The reviewed literature has shown that the nurse, patients, family, and evidence versus non-evidence-based practice are essential in the analysis of the situation. Besides, the setting, the type of catheter, and conditions affect the entire discussion.
Risk Factors Associated with CLABSIs
a. Contamination on Insertion
The catheter may gain entry into the bloodstream during the insertion of the line into the body of the patient. The rate of infections during insertion is substantially dependent on the hygiene levels that are put in place by the health care providers (Dick et al., 2015). The rates of infection during insertion happen to be high showing ignorance or lack of professionalism among the health caregivers. Contamination during insertion may also result from the instruments used and how sterilized they are. Therefore, preventing contamination plays a critical role in caring for patients with CVC.
b. Contaminated Skin of the Patient
The insertion is done on the body of the patient. Infected skin of the patient may contain microorganisms which may enter the body during the insertion (Dombecki et al., 2017). The fact that patients have negligible knowledge concerning the different ways the infection may occur means that there is so much responsibility placed on the health caregivers. The infection rates due to unsanitary practices of the patients seem to have drawn the attention of the authors of the different articles analyzed. With the rates of CLABSIs rising each year, mortality rates have also increased. Researchers have made CLABSIs prevention a priority to address such risk factors to avoid or reduce infection rates. Skin Hygiene of the patients requires additional care for the prevention of CLABSIs.
c. Non-Compliance with the Central Line Maintenance
There are guidelines for healthcare professionals meant to reduce the chances of CLABSIs infection. Such instructions include not using antiseptics and ensuring complete dressing changes (Orwoll et al., 2017). As much as these guidelines and policies are in place does not mean that compliance is definite. Cases of caregivers who do not comply with the stipulated guidelines are common and such levels of unprofessionalism have cost patients their lives. There is evidence that the absence of compliance leads to deleterious issues among patients using the CVC.
Other Risk factors
In a study conducted by Tomar, Lodha, Das, Sood, Kapil, (2016) among the common risk factors for central line infections are factors such as; triple lumen, changing of the central-line, and frequency of accessing the central line. However, avoiding unnecessary changing of the line, educated workers on hygiene and full barrier precautions, as well as ongoing surveillance through regular rounds helped to prevent infections. Of 265 enrolled children with a central line, 13 developed bloodstream infections (incidence density 5.03/1000 central-line days). In another research by Pepin et al. (2015), it is indicated that comorbidity conditions increase the risk for surgical site infections and the acquisition of antibiotic-resistant bacteria.
Additionally, Leistner, Thürnagel, Schwab, Gastmeier, & Geffers, (2015) indicate that when nurses in infant units are few infections rates are high. Taviera et al. (2016) purport that in children-based units, low white blood cell content, malnutrition, and CVC insertion before chemotherapy results in infections. Finally, Xu & Wu (2017) note that implantable ports SCS have the lowest risk while non-tunneled type had a very high risk. Among such factors and age, disease condition, gender (intrinsic factors) as well as prolonged hospital stay, multiple CVCs, CVC duration, internal jugular access, parental nutritional admission and insertion (extrinsic) CVCs are contaminated due to patient’s skin contact with organisms or direct contamination of catheter. There are a wide variety of risk factors for CLABSI. Some have to do with the duration of hospital stay, nutrition, age, other diseases, blood content, surveillance, the number of nurses, gender, and type of CVC. Studies should involve a number of these factors to acquire effective results.
a. Removal of Unnecessary Lines
The authors agree that there are times patients will have lines which are no longer being used for any medical purpose. These are mainly patients who have spent so much time in the hospitals, and the chances of being discharged seem minimal (Sodek, 2016). The caregivers are meant to remove lines once they have served the purpose. The more these lines remain on the body of the patients the more the chances of infection. Bacteria and all other associated microorganisms will quickly enter the body.
b. Health Care Providers to Follow Recommendations
Healthcare professionals are trained on the best practices that are meant to ensure that the chances of patient infections are minimized or even eliminated. Unfamiliarity will occur at times, and the well-being of the patients is jeopardized (Stone et al., 2016). Just like any other profession, health care ties it’s professionals around practices which ensure ethical undertakings to safeguard the lives of the patients. The authors encourage the idea that healthcare professionals should be unbiased to patients and do what their work ethics dictates them to do. Such will ensure improved the health and safety of the patients.
c. Encouraging Teamwork
In any health care setting, there are two main participants. These are the health caregivers and patients. One of the authors suggests that teamwork between these two parties will go a long way in reducing the rates of these infections (Stone et al., 2016). Collaboration will ensure that there is knowledge sharing, that key concerns and risks that may be known to one of the parties are made known to the other. The impact teamwork will have on preventing the cases of CLABSIs in hospitals is immeasurable. The same should be embraced and upheld. The understanding of the intervention process serves as a variable building model as well as a methodological process in studies on CLABSI.
Implementation of policy and surveillance
According to Namita et al., (2015) cooperation between nurses and the patient, e-learning, confidence offers better care for the CVC. Besides, checking pre and post-treatment axillary temperature, keeping the dressing closing, close monitoring of the patient, using aseptic technique, and maintaining CVC through anticoagulant as well as using polyurethane dressing with an external cloth border instead of polyvinylchloride catheter dressing reduce infection. In another study by Commonwealth of Australia, (2016) CLABSI surveillance has to offer a correct definition, blood culture, health-associated infection or HAI-non-inpatient and settings which are often; oncology, hematology, ICU, hospital-wide, high dependency units, and hemodialysis patient. Furthermore, the right timing, correct interpretation, and potential organisms should be established for surveillance to serve in reducing infections in CVC units. According to Tomlinson (2015) the study conducted on the effect of surveillance, in 6 months, the application of interventions right line, right time enhanced reduction on infections. Morrison, Raffaele & Brennaman (2016) to indicate that there is always improvement in service when nurses are given feedback on the CLABSI and risk factors. Out of 620 visually audited lines from 14 nursing units for 16 weeks, 113 lines did not audit. 628 risk factors were established. Through personalized nurse report cards infections decrease. Baldassarre et al. (2015) note when audit tools are used alongside education the compliance of nurses increases. Furthermore, Jones et al. (2017) state that repeated skill assessment enhances the safety of patients with CVC.
El-Sol, A., & Badawy, A.I. (2017) studies how education module affects CABSI and indicates that most of the participants had a diploma in nursing and lacked proper practice for CVC. The pre-and post-education mean scores varied before and after training. It was established that knowledge, experience, and practice positively resulted in lower infections.
Aloushi, S.M. & Alsarai, F.A. (2018) opine that as long as the nurse-percent ration was lowered, the compliance in the patient’s outcome. Perin et al. (2016) postulate that hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement and commitment of staff to preventing infections.
CLABSIs associated infections/Transmissions
a. Hematogenous Transmission
This is an infection that is characterized by a primary tumor penetrating blood vessels. They then get transported in the blood vessels and eventually into the distant parts of the body of the patient (Stone et al., 2016). Once at the distant sites, the cells will penetrate the walls of the vessels again and build a basis for another, a new tumor on the new site. Such are the same cases that happen with CLABSIs. Examples include catheter-associated Urinary Tract Infections (CAUTI) that can lead to CLABSI’s.
A urinary tract infection (UTI) refers to an infection in any part of the urinary system. UTIs are also common healthcare-associated infections reported by both patients and healthcare givers. These infections are associated with urinary catheters, a tube which is used by doctors through the urethra to drain urine (Douglas, 2015). Most of the hospitalized patients end up with urinary catheters inserted in their bladder. Prolonged use of the catheters increases the risks of the infections. Health caregivers should ensure that these catheters are removed when not being used to reduce the risk of patients contracting the CLABSIs.
c. Contaminated Infusates
The term refers to the introduction of pathogens into the body of patients. The introduction of these pathogens occurs through the sterile used by the health care providers. During surgery or during other procedures which may require line insertion, bacteria may be introduced into the body of the patient (Stone et al., 2016). Contaminated infuscate happen to be one of the ways CLABSIs bacteria is introduced into the bloodstream. Patients and the health care providers need to be educated on such risks.
Necessity for Interventions
a. Reduced incidences of CLABSIs
The preventive measures mentioned above by the authors of the different articles will go a long way into reducing the incidents that are reported by patients and caregivers concerning CLABSIs (Klintworth et al., 2015). Encouraging adherence to the hygiene standards, the policies and the recommendations as they relate to CLABSIs infections will enable the creation of an environment that will enhance the well-being of the patients and also minimize the chances of contraction of the infections. CLABS is deadly and is already costing patients and nations profoundly.
b. Reduced morbidity
Morbidity has been defined as how often a disease occurs or is reported in a population. The morbidity rate is determined by examining the number of patients with a particular disease at a given period (Kim & Biorn, 2017). Reduced cases of disease mean that preventive and treatment measures are effectively implemented by all stakeholders involved. CLABSIs infections are no exceptions here. The literature work of the previous authors appreciates that the health care institutions that have adopted the interventions measures above report few and reduced cases of the infection. As such, many studies show that the impact of reducing infection rates is reducing morbidity which shows an improvement in the quality of care in hospitals. It serves in demonstrating the significance of the study as well as a variable.
Safe Costs Containment and Maintaining Profits
In one study by Scott, Sinkowitz-Cochran, Wise, Baggs, & Goates, (2016) indicates that in a study on 40,556 and 75,067 central line-associated bloodstream infections were prevented in Medicare and Medicaid patients in critical care units in the period 1990-2008 with about $ 586-$862 million expenditure and control efforts that lead to saving $44–$131 with net profits of about 664 USD Million. Cost containment and cost saving are one of the motivating factors in the studies on CLABSI prevention.