Introduction:
Central Line-Associated Bloodstream Infection (CLABSI) is a significant healthcare-associated infection (HAI) that is associated with increased morbidity, mortality, and healthcare costs. CLABSI is a bloodstream infection that is acquired when microbes enter the bloodstream through a central venous catheter (CVC). CLABSI is a preventable HAI that can be reduced by following strict infection control measures (Hsu et al., 2016).
Problem Statement:
CLABSI remains a significant cause of morbidity and mortality, particularly in critical care settings. Although there are evidence-based guidelines for preventing CLABSI, implementation of these measures is challenging. Further research is needed to identify effective strategies to reduce the incidence of CLABSI in clinical settings (Hsu et al., 2016).
PICOT question:
In critically ill adult patients with central venous catheters, does the implementation of a bundled intervention reduce the incidence of CLABSI compared to standard infection control practices?
Clinical Setting:
The clinical setting is the Intensive Care Unit (ICU) of a large urban teaching hospital.
Health/Disease Issue:
The health issue is the prevention of CLABSI in critically ill adult patients with central venous catheters.
Brief Synthesized Review:
Several studies have evaluated the effectiveness of bundled interventions in reducing the incidence of CLABSI. For instance, a study by Hsu et al. (2016) found that a multifaceted intervention that included chlorhexidine skin antisepsis, maximal barrier precautions during catheter insertion, and daily assessment of catheter necessity was associated with a significant reduction in the incidence of CLABSI in ICUs.
Another study by Marschall et al. (2014) found that a comprehensive infection prevention bundle that included an alcohol-based chlorhexidine skin preparation, chlorhexidine dressings, and daily review of line necessity was associated with a significant reduction in the incidence of CLABSI.
Case Description:
A 65-year-old critically ill patient was admitted to the ICU and required a central venous catheter for hemodynamic monitoring and medication administration. The patient had a history of diabetes mellitus, hypertension, and chronic kidney disease. The patient was started on a bundled intervention that included chlorhexidine skin antisepsis, maximal barrier precautions during catheter insertion, and daily assessment of catheter necessity. The patient’s central venous catheter was removed after 5 days, and the patient did not develop CLABSI.
Proposed Solutions:
The implementation of bundled interventions has been shown to be effective in reducing the incidence of CLABSI in critically ill patients with central venous catheters. These interventions should include chlorhexidine skin antisepsis, maximal barrier precautions during catheter insertion, and daily assessment of catheter necessity (Hsu et al., 2016; Marschall et al., 2014).
In addition, a study by Garcia-Teresa et al. (2015) found that the use of an antimicrobial lock solution was associated with a significant reduction in the incidence of CLABSI in critically ill patients with central venous catheters. The use of an antimicrobial lock solution may be considered in patients at high risk of CLABSI, although the potential for antimicrobial resistance should be considered.
Conclusion:
The prevention of CLABSI remains a significant challenge in critical care settings. The implementation of bundled interventions that include chlorhexidine skin antisepsis, maximal barrier precautions during catheter insertion, and daily assessment of catheter necessity can significantly reduce the incidence of CLABSI. The use of an antimicrobial lock solution may also be considered in patients at high risk of CLABSI. Further research is needed to identify additional strategies to prevent CLABSI in critically ill patients with central venous cath