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Central Line-Associated Bloodstream Infections (CLABSI)
- A central line bloodstream infection (CLABSI) occurs when bacteria or other germs enter the patient’s central line and then enter into their bloodstream. These infections are serious, but can often be successfully treated.
- Healthcare workers, patients and families can play an active role in CLABSI prevention.
- Most of these infections can be prevented with the correct insertion, cleaning, and care practice of a central line.
What is this measure?
A central line is a catheter that is placed into a patient’s large vein, usually in the neck, chest, arms or groin. The central line is often used to draw blood, or to give critically ill patients fluids and medications more easily. The line can be left in place for several weeks or months if needed.
Sometimes, bacteria or other germs can enter the patient’s central line and enter their bloodstream. This can cause an infection. Johns Hopkins Medicine tracks many different infections, including patients who develop a CLABSI.
Why is it important?
Providing the best and safest care is a top priority of Johns Hopkins Medicine. The Centers for Disease Control and Prevention estimates each year there are 41,000 blood stream infections caused by contaminated central lines in U.S. hospitals.
There are many ways healthcare workers help prevent CLABSIs, including following guidelines for careful and sterile central line insertions. Healthcare workers also follow evidence-based guidelines for the maintenance of central lines, and remove central lines from patients as soon as they are no longer needed.
What is Johns Hopkins Medicine doing to continue to improve?
Providing the best and safest care to our patients is the top priority for Johns Hopkins Medicine. Part of this work includes preventing infections in the hospital, including central line associated bloodstream infections.
Johns Hopkins Medicine follows evidence-based guidelines and best practices with the goal of eliminating all CLABSIs. One of the mechanisms in place for CLABSI prevention is that staff use a specific central-line insertion checklist to ensure central lines are inserted as safely as possible. The checklist details each action that must be taken before, during, and after the insertion of a central line. Johns Hopkins Medicine also uses supply bundles and kits for central lines, so that staff have all of their materials and supplies easily accessible in one place.
Monitoring adherence to best practices for central-line maintenance is also an important part of CLABSI prevention. Johns Hopkins Medicine monitors compliance with the central-line maintenance bundle, which includes the monitoring of dressings and tubing.
Johns Hopkins Medicine staff are always reassessing and evaluating if a central line is still needed with the goal of removing the central line as soon as possible.
Kimberley V. Kelly, R.N., B.S.N., M.B.A.
Critical Care Nursing Director, Suburban Hospital
“I am very proud of the work our team has done to nearly eliminate central line-associated blood stream infections (CLABSIs) in our ICUs. We participated in the Maryland Patient Safety Institute’s On the CUSP Project to reduce CLABSI rates from 2010 to 2012, and our ICUs had success with being CLABSI-free for 28 months during the project.
To ensure a consistent approach for placing central lines, our ICUs use a procedure cart that is organized with exactly the same contents. This helps ensure that we have the materials we need to place the line correctly and safely. Everyone who is present during a line placement knows to observe the sterility of the procedural area.
A big part of our success is the cultural shift we have seen with our staff toward the idea of ‘ownership’ of central lines. We all ‘own’ the lines, and we maintain them carefully, paying close attention to creating a sterile room for insertion and keeping the line for only as long as necessary. Removing the line as soon as possible is one key to avoiding infection. We also changed to a different dressing to keep heavy catheters better secured.
Change takes time, and we recognize that changing practices can create resistance. But our goal is zero infections; simply accepting a low rate of infections is not an option for us. We are dedicated to keeping up the enthusiasm and making sure our initiative stays on track to protect our patients.”
How can patients and families support safety?
Patients and families should alert staff members if they notice the central line dressing coming off or becoming wet or dirty. They should also only touch the central line after performing hand hygiene. Patients and families can also ask their health care provider if they have performed hand hygiene before touching the line. They are encouraged to speak up if they have any concerns. Visitors also need to follow good hand hygiene practices by washing their hands before entering and leaving patients’ rooms.
Patients and families will be provided instructions on how to care for a central line if the patient leaves the hospital while the central line is still in place.
Communicating with Your Health Care Team
Hospital stays and medical treatments can be stressful for patients and families. Communication can be challenging, and it may be difficult to know what questions to ask your health care team.
Patients and families should feel empowered to effectively communicate questions and concerns with their doctors, leading to better, safer health care.
- Doctella, a resource developed in consultation with patient safety physician experts at Johns Hopkins Medicine is an online tool that provides patients with specialized checklists of questions to ask their health care team and to-do lists to get organized before a medical procedure, surgery or exam.
- The Centers for Disease Control and Prevention CLABSI Patient Education
- The Centers for Medicare and Medicaid Services' Hospital Compare