The definition of central line-associated blood-stream infections (CLABSI) are systemic infections with the central venous catheter (CVC) is its source and when other sites of infection have been excluded (i.e. the isolation of the same microorganism from blood cultures and the CVC in significant numbers) . CVCs are colonized by microorganisms on either the endoluminal or the external catheter surface beneath the skin and originate from microorganisms colonizing the patient’s skin at the insertion site or the hands of the staff during insertion or contaminating the hub during care interventions. Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, are the microorganisms most frequently implicated in CR-BSI. Other microorganisms commonly involved include Staphylococcus aureus, Candida spp and enterococci.
2. Burden of disease.
CLABSI represents 10% of all healthcare associated infections (HAIs) and are the fourth most common HAIs in acute care hospitals in Europe according to the ECDCs annual report from 2008. The prevalence of CLABSI in intensive care is higher and represents 30% of HAIs, being the second most common type of infection after respiratory infections in intensive care settings. The incidence of CLABSI is estimated to 2.7/1000 catheter days and the literature suggests that up to 70% of CLABSI could be prevented if adequate measures are undertaken . In the most recent national prevalence survey in the UK, the Health Protection Agency reported that the prevalence of CLABSI was 0.5%, accounting for 7.3% of the HAIs detected. Mortality and morbidity from CLABSI are substantial and is costly for the health care system since CLABSI increase antibiotic use and length of stay in intensive care and the hospital. It is estimated that each year in the United States, central venous catheters may cause 80,000 catheter-related bloodstream infections and, as a result, up to 28,000 deaths among patients in intensive care units (ICUs) . In a study from Spain the attributable mortality from CLABSI in intensive care was 10% and the medium length of stay was 13 days longer for patients with CLABSI compared to controls .
3. How to prevent - specific requirements.
General conditions must be met to prevent HAIs described elsewhere regarding education of staff, surveillance and infrastructure. The following recommendations are based on three recent guidelines [5-7].
A. Before insertion:
B. Principles for insertion:
c. Principles for maintenance: