Central line associated bloodstream infection

Central line devices are vital to care, but they are associated with the risk of infection. 

 Central line associated bloodstream infection (CLABSI) may increase antibiotic exposure, hospital stay, medical costs, and the risk of death. 

CLABSI associated with increased risk of death compared to those who do not have this infection.

CLABSI are often preventable and in recent years there has been marked reduction in CLABSI rates.

A catheter related bloodstream infection is defined with signs and symptoms of infection of fever, elevated white blood count, erythema at the catheter site, and when blood culture is positive.

There are four routes for catheter contamination: skin pathogens at the insertion site can enter the cutaneous catheter tract and migrate down the external surface of the catheter towards the tip.

Insertion site contamination can occur also when skin microorganisms increase underneath the catheter dressing overtime.

A second source of catheter contamination can occur when the catheter hub is manipulated and pathogens gain access to the intraluminal surface of the device, which adhere into a biofilm matrix of extracellular polymeric substances allowing for sustained infection and hematogenous spread.

Thirdly, catheters can become contaminatedhematogenously from a secondary bloodstream infection from another focus, such as pneumonia, or UTI. 

Bacteria stick to the biofilm that is formed and adhere to the internal lumen of the catheter.

The force mechanism for catheter infection is contaminated infusate taints the catheter.

Most catheter related bloodstream infections  (CRBSI) occur now in non-ICU units and in an outpatient setting.

Catheter bloodstream associated infection risk is increased by patient immunocompromise related to hematologic cancers, neutropenia, malnutrition, prolonged hospital stay before device insertion, severe burns, BMI of more than 40, and prematurity in infants.

Increased risk is associated with insertion of the catheter under emergency conditions, incomplete adherence to  sterile insertion technique, multiple manipulations of the catheter, low nursing staffing, and failure to remove unnecessary catheters, catheter device characteristics, the site of insertion, the number of lumens, and the indication for use of the catheter.

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