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Central Line-Associated Bloodstream Infections


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Overview

Central line-associated bloodstream infections (CLABSIs) occur when germs enter the bloodstream through a central line. A central line is a tube that is placed in a large vein to give fluids, blood, or medications, or to do certain medical tests quickly.

Some patients may be at higher risk for developing a CLABSI due to length of hospitalization before catheterization, duration of catheterization, prematurity, underlying medical conditions, location of catheter placement, or other factors. (citation)  It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.


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Estimated burden of CLABSIs in healthcare facilities in the United States:

  • Morbidity
    • Bloodstream infections represent 10% of all HAIs, comprising an estimated 71,900 infections in U.S. hospitals annually. (citation)
      • More than three-quarters (84%) of bloodstream infections in acute care hospital settings are estimated to be associated with a central line.
      • An estimated 15,600 central line-associated bloodstream infections occur in non-neonatal intensive care units annually.
    • According to the 2012 CDC National and State HAI Progress Report, in 2012, an estimated 30,100 catheter-associated urinary tract infections occurred in hospital critical care units and inpatient wards.
    • 2011 CDC Vital Signs Report (citation)
      • Approximately 41,000 CLABSIs in acute care hospitals each year.
        • In 2009, about 18,000 CLABSIs occurred  in patients in intensive care units
        • About 23,000 more occurred in patients who got treatment in other areas of the hospital
      • In 2008, about 37,000 CLABSIs occurred in patients receiving outpatient hemodialysis treatment
    • CLABSIs lead to longer length of hospital stay.
  • Mortality
    • Of patients who get a CLABSI, up to 1 in 4 die. (citation)
  • Costs (citation)
    • Estimated cost per infection ranges from $6,000 - $29,000
    • Estimated total cost in the United States ranges from $0.6 billion - $2.7 billion annually
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In July 2008, Virginia hospitals with one or more adult intensive care units began reporting their CLABSI data to the Virginia Department of Health (VDH) through the National Healthcare Safety Network (NHSN) and have been reporting on a quarterly basis since then.  For more information on these data and the state regulation mandating their reporting, please see Public Reporting page.

In January 2011, the Centers for Medicare and Medicaid Services (CMS) began requiring acute care hospitals participating in their Inpatient Prospective Payment System (IPPS) to report CLABSIs in adult, pediatric, and neonatal intensive care units. These data will be made publicly available on Hospital Compare.

VDH HAI Program activities to address this issue:


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Prevention Strategies for Healthcare Providers

To prevent CLABSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:
  • Follow recommended central line insertion practices to prevent infection when the central line is placed, including:
    • Perform hand hygiene
    • Apply appropriate skin antiseptic
    • Ensure that the skin prep agent has completely dried before inserting the central line
    • Use all five maximal sterile barrier precautions:
      • Sterile gloves
      • Sterile gown
      • Cap
      • Mask
      • Large sterile drape
  • Once the central line is in place:
    • Follow recommended central line maintenance practices
    • Wash hands with soap and water or an alcohol-based handrub before and after touching the line
  • Remove a central line as soon as it is no longer needed. The sooner a catheter is removed, the less likely the chance of infection.

2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections

SHEA/IDSA Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals - CLABSI

CDC CLABSI toolkit for non-intensive care unit (ICU) settings – contains background on epidemiology of CLABSIs as well as core and supplemental prevention strategies


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Tools and Resources

APIC Guide to the Elimination of Catheter-Related Bloodstream Infections, 2009

CDC National Healthcare Safety Network (NHSN) Validation Guidance and Toolkit for 2012: Validation for Central Line-Associated Bloodstream Infection (CLABSI) in Intensive Care Units – resource to assist with internal or external validation of CLABSI data from ICUs. Includes recommended approaches to investigate and enhance the accuracy and completeness of 2012 CLABSI data in NHSN.

CDC Vital Signs Report: Making Health Care Safer – Reducing Bloodstream Infections (March 2011) – latest findings of progress on CLABSI prevention in different healthcare settings (hospitals and dialysis centers)

Comprehensive Unit-Based Safety Program (CUSP) – safety project designed to improve safety culture and reduce CLABSI infections in participating hospitals.  In Virginia, this project is led by the state hospital association, Virginia Hospital & Health Association (VHHA).

NHSN CLABSI protocol, training, forms, analysis resources, and support materials – click on the appropriate healthcare setting and select the CLABSI link to access the materials

SHEA Patient Education Guide (BSI) – fact sheet that educates patients and their families about 7 types of HAIs (including CLABSIs) and how to work with healthcare professionals to prevent them.

VHQC – Healthcare-Associated Infections section contains central line daily assessment form and central line insertion practices monitoring tool

For more patient resources, please see the Consumer and Public Information page or go to the CDC CLABSI website.

Citation:
Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med 2014;370:1198-208. To access the full article, link through this website: http://www.cdc.gov/HAI/surveillance/index.html (click top link)

Last Updated: 04-03-2014

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