CLABSI PI
PROJECT
CVAD
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A CVAD (central venous access
device) is a long tube called
catheter inserted into large
blood vessels
Indications for CVADs:
- Frequent transfusions
- Frequent blood draws
- Hemodialysis
- Parenteral nutrition (PN) or
total parenteral nutrition
(TPN)
- Long term meds or such as
antibiotics
- Chemotherapy
CLABSI
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CLABSIs (central line associated
bloodstream infection) occurs
when bacteria enters the
bloodstream through a central
line.
Patients suspected of having a
CLABSI can have a fever and
may have soreness and redness
around the central line site
CLABSIs are highly preventative
and can be easily avoided if
proper sterile techniques are
used.
CLABSIs can cost between
$3,700 to $39,000 per episode
(Marschall et al, 2014)
Who’s at risk for CLABSIs?
According to Infection Control and Hospital
Epidemiology published by Cambridge University
Press, those at most risk for CLABSIs include the
following:
- Prolonged hospitalization before
catheterization
- Long term use of catheter
- Neutropenia
- Reduced nurse-to-patient ratio in the ICU
- Total parenteral nutrition
- Substandard or improper catheter care
(excessive manipulation, improper sterile
techniques)
- Femoral or jugular catheterization
- Lack of sterility at insertion site or catheter hub
- Transfusion of blood products
CLABSI Statistics Over the Years
2015
2016
2017
~26,000 cases/
26,200 predicted
~23,500 cases/
26,500 predicted
~21,200 cases/
26,000 predicted
2018
2019
2020*
~19,200 cases/
26,000 predicted
~18,000 cases
26,100 predicted
~21,400 cases/
25,000 predicted
The CDC uses a metric
called SIR (standardized
infection ratio) in order to
monitor HAIs at any level.
SIRs are calculated by
dividing the actual amount
of infections to the predicted
amount. The CDC’s goal is
to have a CLABSI SIR of
≤0.5.
Strategies to Prevent CLABSIs
Prior to Catheterization
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List of indications for CVAD
Educate healthcare personnel on
insertion, care and removal of
catheter
Bathe ICU patients daily in
chlorhexidine (may be used in
long-term as well)
Ensure and document aseptic
techniques
Perform hand hygiene before
inserting or manipulation
catheter
Use a kit that comes with all
needed supplies
During/Post Catheterization
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Use chlorhexidine for skin prep
Disinfect catheter hubs, needleless
connectors, and injection ports
before accessing the catheter
Remove unneeded catheters
Change transparent dressings and
perform CVAD care every 5-7 days
or PRN for soiled, loose, and/or
damp dressing; gauze dressings
should be changed every 2 days
Each dressing change should have
initials, date and time recorded on
dressings
According to Infection Control and Hospital
Epidemiology Journal
Trinitas Policy
Central venous catheters are inserted by physicians or residents who are certified to
perform the procedure.
The physician will follow the standardized protocol for central line insertion using the central
line insertion checklist:
1. Hand Hygiene
2. Appropriate insertion kit
3. Surgical cap and mask
4. Sterile gloves, sterile gown
5. Full sterile drape
6. Store prep with chlorhexidine
7. Maintenance of sterile field throughout procedure
8. Ultrasound guidance, if necessary
9. Chlorhexidine patch and sterile field throughout procedure
10. Upon completion of midline catheter insertion the physician/resident will document the
procedure in clinical informatics system
Dressing maintenance
Transparent dressing & anchor device, use aseptic technique and standard central line
dressing kit, change when loosened, moist or soiled or every 7 days. Use chlorhexidine
patch disc at insertion site; change with dressing change
CDC Guidelines
For Clinicians, Follow proper insertion practices
1. Perform hand hygiene before insertion
2. Adhere to aseptic technique
3. Use maximal sterile barrier precautions
4. Choose the best insertion site to minimize infections and noninfectious complications
based on individual patient characteristics.
5. Prepare the insertion site with >0.5% chlorhexidine with alcohol
6. Place a sterile gauze dressing or a sterile, transparent, semipermeable dressing over
the insertion site.
Handle and maintain central lines appropriately
● Comply with hand hygiene requirements
● Bath ICU patients over 2 months of age with a chlorhexidine
● Use only sterile devices to access catheters
● Immediately replace dressings that are wet, soiled or dislodged
● Perform routine dressing change using aseptic technique with clean or sterile gloves.
● Change gauze dressing at least every two days or semipermeable dressing at least
every seven days
Trinitas Central Line Performance
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Bibliography
“2020 National and State Healthcare-Associated Infections (HAI) Progress Report.” Centers for Disease
Control and Prevention, Centers for Disease Control and Prevention, Oct. 2021,
https://arpsp.cdc.gov/profile/infections/clabsi?redirect=true&year-select-report=year2020.
Marschall, J., Mermel, L. A., Fakih, M., Hadaway, L., Kallen, A., O’Grady, N. P., Pettis, A. M., Rupp, M. E.,
Sandora, T., Maragakis, L. L., & Yokoe, D. S. (2014). Strategies to Prevent Central Line–Associated
Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology,
35(7), 753–771. https://doi.org/10.1086/676533