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Central Line-Associated Bloodstream Infections
Central Line-Associated Bloodstream Infections (CLABSI), are bloodstream infections caused by entry of microbial pathogen into the blood through the catheters used during the medical procedures of drawing blood or giving of fluids and medication. According to Watcher (2012), over 20,000 people in the United States die annually as a result of CLABSI. At the same time, most CLABSI occur in the wards and in the intensive care units in common health care facilities. Most of the CLABSI infections occur as blood infections associated with the use of the catheter during blood circulation and related procedures. This discussion will explore the types of error associated with CLABSI, a review of the related literature and create a patient safety guideline that should be adopted to prevent the problem.
The type of error
CLABSI infections take place because of the entry of bacteria and disease causing pathogens into the bloodstream during the processes of using catheters in the blood. A central line is used in treatment by placing it in the patient’s large vein of groin, neck, chest or arms (O’Grady, 2011). The errors that lead to the infection take place when the bacteria enter through the catheter and travels to the bloodstream. The incident is high risk because it involves the very equipment or processes that are considered safe and used in day to day treatment procedures (O’Grady, 2011). The infection by the disease causing pathogens causes illnesses that range in severity depending on the type of the pathogen and immunity levels of the victim.
One of the multidisciplinary responsibilities for CLABSI is the physician responsibility to ensure that the process is free of external entry of pathogens via the catheter. The other responsibility is for the staff to ensure the sterilization and cleanliness of the equipment used. Both the physician and the staff should adhere to the rules, the procedures and preventive measures (Timmel et al, 2010). However, the main barrier that reduces the teamwork is the lack of teamwork between the people responsible for the procedural processes that prevent the occurrence of CLABSI (O’Grady, 2011). The occurrence of CLABSI in a health care setting is mostly because of the lack of adherence to the safety measures. However, health care providers have the resources like sterilization equipment and safety, cleaning tools for ensuring the prevention of the occurrence of the CLABSI.
Literature Review
The occurrence of CLABSI may lead to illnesses that may lead to death if extreme and untreated appropriately. Peredo et al (2010), argues that CLABSI cases are fatal while others increase the level of stay in the hospitals by the patients. The increase in the stay in the hospital increases the cost of treatment for both the patient and the hospital. Shah et al (2013) reports that increase in length of stay in hospital is between 10 to 20 days, which costs hospitals between $4000 and $56000. According to Stephen (2011), CLABSI cases are reported in around 3% of catheterization procedures. However, this statistic can be as high as 16% if the right measures are not taken, and can be lower if proper procedures are adhered to (Stephen, 2011).
According to a research by Shah et al (2013), the incidences around 33% of the incidences reported in the united states occurred in the ICUs. This is because of the high level of catheterization procedures that take place in ICUs compared to other places in a hospital setting. The risks of infection of the CLABSI are categorized into patient, catheter and operator factors. Patient factors include compromised skin integrity, granulocytopenia, presence of distant infection and the severity of illness (Shah et al, 2013). Catheter factors include the type of the catheter and treatment of catheters (Shah et al, 2013). According to Timmel et al (2010), the coating of catheters with antimicrobial or antiseptic reduces infection. Moreover, risk factors relating to operators include cleanliness, adherence to procedures and expertise of the operators.
The history of occurrence of CLABSI dates back to 1929 when Forssmann first introduced the initial stages of central venous catheterization (CVC) (Shah et al, 2013). Over the time, the use of intravascular devices has reached to the level of over 150 million devices per year in the United States only (Shah et al, 2013). Due to the increased use of the intravascular devices, blood stream infections resulting from their use increased, which also elevated the cost implications. As a result of the increase in the CLABSI cases, and the implications of the resulting complications, the need for safety measures has since been prioritized both in the United States and the world (Shah et al, 2013).
To manage the resultant situations, there are regulations that have been set for health care providers and institutions that are related to CLABSI cases. One of the regulations is the cleanliness of the health care operators of the intravascular devices and the staffs that are involved in the catheterization procedures (O’Grady, 2011). Another regulation is the proper sterilization of the equipment used in the catheterization procedure to avoid infection by the microbial pathogens (Timmel et al, 2010). This involves procedures that are laid for the physicians and the staff that are involved in the catheterization procedures. In addition, regulations have been put to require the patient cleaned before the catheterization procedure (Shah et al, 2013). For patients going home with the intravascular devices, proper procedures should be communicated and taught to them by physicians responsible.
In addition, there are interdisciplinary and collaborative efforts that are set to reduce potential causes of CLABSI to patients and promote safety of patients. The interdisciplinary include the adherence to the standard procedures that are set in an attempt to ensure the safety of the procedures. In addition, the staff at the health care providers should demonstrate knowledge of the risk factors in order to avoid the materialization of the risk of CLABSI (Timmel et al, 2010). Collaborative efforts involve cooperation between the physicians that carry the catheterization procedures and the nursing staff at the health care facilities. All the staff members should collaborate to ensure cleanliness of the intravascular devices and the equipment used (Timmel et al, 2010). They should also collaborate to control each other by ensuring they all adhere to safety procedures. The collaboration in the activities helps in the reduction of the risk factors and eventually the CLABSI that can be reported.
Patient Safety Action Plan
According to Watcher (2012), the Keystone Project is a conceptual model for the prevention of the hospital related diseases such as the CLABSI and promotion of patient safety. This model is an appropriate theoretical model for preventing CLABSI. The use of the model is appropriate because it aims at preventing major hospital-related infections in a comprehensive manner and in all the sections of treatment (Pronovost, 2010). Practiced in Michigan Hospital, the Keystone Project seeks the implementation of safety measures through rigorous practices that focus on the effectiveness of measures taken. According to Pronovost (2010), the hospitals that participated in the Keystone Project recorded a significant reduction in the levels of catheter-related bloodstream infections and low or no cases of bloodstream infections.
The model sought to reduce the risk for cases of CLABSI and for the prevention of the infections (Pronovost, 2010). One of the main aspects and outcomes for the risk reduction is the cleanliness of the physicians and the staff. This is a key step of the patient safety action plan because it requires the medical workers to maintain high levels of cleanliness in order to prevent the occurrence of CLABSI. In addition, proper treatment and disinfection of the catheter and other equipment is a necessary requirement of the action plan.
As part of the patient safety action plan, patients should be trained on the basic requirements of cleanliness and its significance in their safety. This is one of the main learning needs that is necessary in order for the plan to be successful in reducing the risks of CLABSI (Peredo et al, 2010). In addition, there are learning needs of the medical staff at the treatment facilities. In this regard, physicians and assistant staff require adequate training on the safety plan and the risk factors for CLABSI.
One of the goals that will facilitate the plan implementation is thorough education. Both the medical staff and the patients require sufficient education on the risk factors for CLABSI and the prevention methods. Secondly, cleanliness of the equipment and catheters used in the treatment processes is a significant goal for both the medical staff and the medical facility (Peredo et al, 2010). Thirdly, the goal for a quantitative reduction in CLABSI cases, or the target is needed to give the medical staff the direction towards the prevention of the occurrence of the infections. Fourthly, monitoring patient progress is an important goal of ensuring reduced infections and cleanliness. This and other goals will facilitate the implementation of the safety plan.
References
Shah, H., Bosch, W., Thompson, K.M., & Hellinger, W.C. (2013). Intravascular Catheter-Related Bloodstream Infection. The Neurohospitalist. 2013 Jul; 3(3): 144–151
Pronovost, P.J., Goeschel, C.A, & Colantuoni, E. et al. (2010). Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309
Stephen, F. (2011). Catheter-related bloodstream infection. Contin Educ Anaesth Crit Care Pain 2005, 5 (2): 49-51
Timmel, J., Kent, P.S., & Holzmueller, C.G. et al. (2010). Impact of the Comprehensive Unit-Based Safety Program (CUSP) on Safety Culture in a Surgical Inpatient Unit. Joint Commission Journal on Quality and Patient Safety, 2010; 36(6): 252-260
Peredo, R., Sabatier, C., Villagrá, A., González, J., Hernández, C., Pérez, F., Suárez D., & Vallés, J. (2010). Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention. Eur J Clin Microbiol Infect Dis, 2010, Sep;29 (9): 1173-7
O’Grady, N.P., Alexander, R., Burns, L.A., et al. (2011). Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control, 2011; 39 (4 suppl 1):S1–S34
Watcher, R. (2012). Understanding Patient Safety, Second Edition. New York: McGraw Hill Professional