CLABSI RATES AND PREVENTION 1

Running head: CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION

RATES AND PREVENTION

Central Line Associated Blood Stream Infection Rates and Prevention

Howard Derby

Delaware Technical and Community College

NUR340 Nursing research

Dr. Kathleen Heacock

November 4, 2019
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Central Line Associated Blood Stream Infection Rates and Prevention

This research paper analyzes the rates of Central Line Associated Blood Stream

Infections (CLABSI) and how hospitals are preventing further infections. Most hospitals claim

they are committed to protecting their patients and reducing the number of infections. Hospitals

have an obligation to reduce the risk of hospital-acquired infections (HAI) by developing

policies that promoting safe procedures for all employees, patients and visitors. HAIs are 100%

preventable and are the sole fault of the hospital. In Delaware, there are approximately 250,000

CLABSI occurrences per year with 80,000 being in the Intensive Care Units (Christiana Care,

2019). With education and proper monitoring, CLABSI and HAI rates can be prevented.

Statement of the Problem

There is a plethora of research on CLABSI rates and prevention. Nurses who administer

IV’s at their job require some educational background for CLABSI occurrences and should

complete as much training as possible on the current trends. Some hospitals are behind the curve

or have failed to adopt CLABSI updates. Although, use of peripheral intravenous access is

common in most hospitals, its presence is far from benign, with a reported 35% to 50% failure

rate, even in facilities with a dedicated infusion team (Nickel, 2019). CLABSI and HAI research

is continually updated and should require the hospital nurse to complete education on the subject.

Literature Review

Back in 2007-2011, research showed how having a specialized IV team to perform IV’s

throughout the hospital was successful in decreasing rates of CLABSI (Decary, 2011). This

study was performed in the NICU of a hospital consisting of specific bedside nurses trained to

insert, monitor insertion site and remove IV lines.

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Other research consisted of a six-month study monitoring the occurrence of CLABSI

rates in all departments of an Italian tertiary care children’s university hospital. Children

admitted to Meyer Children’s University Hospital in Florence, Italy who had a central line access

between October 15, 2014 and April 14, 2015, were studied to determine any CLABSI

occurrences. The study confirmed the spreading of multi-resistant pathogens as causes of

healthcare associated infections in children (Venturini, 2016). In addition, an increased incidence

rate of CLABSI was related to underlying specific medical conditions of the patients. This

research concluded that more studies are needed to understand risk factors and interventions.

Christiana Care is required to report any HAIs directly to an agency within the State of

Delaware. Christiana states that “One infection is one too many” so they have been aggressively

working to prevent and control all HAIs. Their focus is on transparency and accountability.

Christiana believes they can achieve better outcomes by sharing health information, setting

priorities, and establishing procedures and measures to track HAI data. Some measures taken by

Christiana to prevent HAI and CLABSI include; proper hand hygiene, sterile clothing, use of

special central-line catheters, special soap, using the best vein, and close, daily monitoring.

Christiana also wants patients and families to be part of the prevention by asking questions,

reminding everyone to wash their hands, and making sure the patient is closely monitored by

health care professionals (Christiana Care, 2019).

The CDC provides informational links that outline the types of research studies used to

develop policies to prevent CLABSI and HAI’s. Some of these include surveillance, existing

hospital policies, and infrastructure requirements that consist of adequate staff and training. If

adhered to and adopted, the CDC guidelines can help end CLABSIs. They also provide a way to
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monitor the rates of CLABSI and assess the effectiveness of prevention efforts through CDC’s

National Healthcare Safety Network (CDC, 2019).

Analysis

There is current and innovative research involving CLABSI standards of practice in

practically every healthcare facility that deals with the problem. The methodologies used for this

research were predominately case studies and evidence based practice. Some of the major

findings and of the research include specialized IV nurses, standard practice of hygiene and

reporting. Some gaps in the research include patient risk factors and urgency in IV placements.

For those issues, not all the conclusions apply. Although use of the most current evidence based

recommendations is an expectation within health care, there are multiple barriers between

creation of new knowledge and its direct application to patient care (Nickel, 2019). The

conclusion that healthcare providers should look at the current literature and guidelines and work

within their own institutions to develop programs and policies to guide and assist them in

preventing CLABSI may cause conflicting polices. There needs to be a universal standard to

prevent CLABSI and HAIs.

The Center for Disease Control (CDC) holds that CLABSI’s result in thousands of deaths

each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections

are preventable (CDC, 2019). The patient-related costs attributed to catheter-related bloodstream

infections are estimated to add seven to twenty days of hospitalization and up to $56 000 in costs

per case (Nickel, 2019).

A self-administered questionnaire given to nurses working in hospitals in Italy gathered

information about practices for the prevention of CLABSI. The vast majority of the three

hundred and thirty-five nurses answered questions correctly about the main recommendations to
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prevent CLABSIs including; use of sterile gauze or sterile transparent semipermeable dressing to

cover the catheter site, disinfect the needleless connectors before administer medication or fluid,

disinfect with hydrogen peroxide the catheter insertion site, and use routinely anticoagulants

solutions (Esposito, 2017). This study demonstrates that their nurses have an adequate level of

knowledge concerning evidence-based recommendations for preventing CLABSI.

Recommendations

Consistent application of evidence-based standards of practice in all aspects of IV care is

essential to avoid CLABSI and HAIs. Future research involving a case study approach can help

to illustrate the practice of IV placement and help indicate problem areas. Having research

studies at hospitals where the researcher follows an IV nurse could help assess early recognition

of complications or policies that are no longer recommended. This study could be titled “In-

person research of CLABSI” since the researcher is actually following the nurse during their

shift. This is a case study methodology and will have its pros and cons. It will promote case

study research but may make the nurse nervous in conducting their job responsibilities.

There are reoccurring recommended strategies for CLABSI prevention that are

categorized as basic principles or special approaches (Marschall, 2014). Basic care includes

sterile equipment, gloves, and hand hygiene. Special approaches apply to patient populations

with certain illnesses or require special dressings. Specialized hospitals also may implement a

more intensive strategy. Educational interventions are very important and should be

implemented to address the gaps regarding knowledge and practice and to ensure that nurses use

evidence-based prevention interventions to prevent CLABSI rates (Esposito, 2017).

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References

Bannatyne, M., Smith, J., Panda, M., Abdel-Latif, M. E., & Chaudhari, T. (2018) Retrospective

Cohort Analysis of central Line Associated Blood Stream Infection following

Introduction of a Central Line Bundle in Neonatal Intensive Care Unit. International

Journal of Pediatrics, 1–8. https://doi-org.libproxy.dtcc.edu/10.1155/2018/4658181

Centers for Disease Control and Prevention. (2019) Healthcare-associated Infections; Central

line-associated Blood Stream Infection. Doi: https://www.cdc.gov/hai/bsi/bsi.html

Christiana Care (2019) Quality and Patient Safety, Preventing Infections. Doi:

https://christianacare.org/about/patientsafety/preventinginfections/

Conley, S. B. (2016) Central Line-Associated Bloodstream Infection Prevention: standardizing

practice focused on evidence based guidelines. Clinical Journal of Oncology Nursing.

20(1), 23–26. https://doi-org.libproxy.dtcc.edu/10.1188/16.CJON.23-26

Décary, et al. (2011). Four-year surveillance of central line-associated bloodstream infection

(CLABSI) in neonatal intensive care unit (NICU). BMC Proceedings, 5(Suppl 6):O8.

Doi:10.1186/1753-6561-5-S6-O8

Esposito MR, Guillari A, Angelillo IF (2017) Knowledge, attitudes, and practice on the

prevention of central line-associated bloodstream infections among nurses in oncological

care: A cross-sectional study in an area of southern Italy. PLoS ONE 12(6): e0180473.
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https://doi.org/10.1371/journal.pone.0180473

Marschall, J., Mermel, L., Fakih, M., Hadaway, L., Kallen, A., O’Grady, N., . . . Yokoe, D.

(2014). Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute

Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35(7), 753-

771. doi:10.1086/676533. https://www.jstor.org/stable/10.1086/676533

Nickel, B. (2019) Peripheral intravenous access: applying infusion therapy standards of practice

to improve patient safety. American Association of Critical-Care Nurses 39;1. doi:

https://doi.org/10.4037/ccn2019790

Venturini, E., Montagnani, C., Benni, A., Becciani, S., Biermann, K. P., De Masi, S., … Galli, L.

(2016). Central-line associated bloodstream infections in a tertiary care children’s

University hospital: a prospective study. BMC Infectious Diseases, 16, 1–7. https://doi-

org.libproxy.dtcc.edu/10.1186/s12879-016-2061-6