Melissa A. Grier, MSN, APRN, ACNS-BC
Central line-associated bloodstream infection (CLABSI) is one of the hottest topics in healthcare. What are the best prevention methods? How can we reduce associated costs? More and more products are being created to combat this seemingly undefeatable foe. Although the innovations are helpful in many settings, there are some basic interventions that have been proven effective as well.
Sometimes the simplest intervention is the most effective. Take a moment and mindfully reflect on your hand-hygiene practice.Do you routinely foam in when entering a patient room and foam out as you’re leaving? Do you perform hand hygiene prior to applying gloves when you’re getting ready to access a central line? It’s easy to rush past this imperative task. Increase mindfulness regarding your hand-hygiene habits and you can rest assured that you’re decreasing your patients’ risk for CLABSI.
SCRUB THE HUB
Prior to accessing a central line lumen or port, scrub it with your facility’s approved device cleansing swab. The lumen or port should be cleaned every time you’re preparing to access. For example, when administering an antiemetic, scrub the hub
, connect a saline flush to assess patency, scrub the hub again
, administer the antiemetic, scrub the hub a third time
, and connect another normal saline flush to clear the line.
If your facility uses heparin or sodium citrate to “lock” lumens between uses, scrub the hub again before connecting that syringe. Yes, you’re going to be doing a lot of scrubbing. Use the time to chat with your patient about all the ways you can work together to prevent infection.
The duration of scrubbing varies depending on the product being used. Because the product won't be effective if you don't scrub long enough, read the instructions for use to ensure that the product is being used according to the manufacturer’s recommendations. Generally, 10 to 15 seconds of scrubbing is recommended when using alcohol swabs. Device swabs containing chlorhexidine gluconate may decrease the scrub time to 5 seconds.
FLUSH THE LINE
Patency is very important for central line functionality, but it also plays a major role in preventing infection. When a line isn’t flushed well after being used, the particulate matter left behind (especially from blood products and total parenteral nutrition) becomes a breeding ground for microbial growth. The average person may not develop a CLABSI, but patients with compromised immune systems are highly susceptible to infection and subsequent sepsis related to microbial growth within a central line. Follow your facility’s policy regarding the frequency of flushing central lines. Ensure that scheduled and additional flushes as needed are ordered and administered from the time the line is initially placed until the line is discontinued.
INVOLVE THE PATIENT
As you’re performing central line care, explain the rationale for your actions. Explain when patients and their caregivers will be responsible for central line maintenance outside of the acute care setting. Also, teach them about the importance of hand hygiene, scrubbing the hub, flushing the line, and maintaining the integrity of the dressing.
Despite our best efforts, sometimes CLABSIs will occur. Review signs and symptoms of infection with your patient and their caregivers. Discuss the process for seeking immediate intervention and make sure they have contact information for a resource to address any concerns they have after hours.
GET RID OF IT
We often fall in to the trap of leaving a central line in place “just in case” the patient needs it. Though the intention is good, the risk is definitely greater than the benefit. When the line is no longer indicated, it needs to come out.
For more information, visit: The Joint Commission CLABSI Toolkit
, and ANA/APIC Resource Center