Hot topics in diagnosing, preventing, and treating central line associated bloodstream infections

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Jennifer Blumenthal, MD, an instructor, pediatric infectious diseases and critical care medicine at Boston Children’s Hospital and Harvard University School of Medicine in Massachusetts provided an update on recent literature related to central line associated bloodstream infections (CLABSIs) in children.

A CLABSI is defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of central venous catheter (CVC) placement.

Nationally across institutions during the COVID-19 pandemic, there was a rise in rates of CLABSIs. This trend was likely multifactorial due to an increased severity and acuity of patients, hospital staff shortages, additional demands upon infection and prevention control staff, and disruptions in typical procedures and supply chain issues.

Previously known risk factors for CLABSI development in children include clinical host-specific factors and situation-specific factors that can be explained by the known pathogenesis of CLABSIs. Specifically, previously known risk factors for CLABSIs include immunocompromised status such as neutropenia, prematurity among infants, multiple manipulations of the catheter and low nursing-to-patient ratios.

Blumenthal cited a recent study evaluating the outcomes of 8629 hospitalized patients with central lines identified significant disparities by race and language. After adjusting for known risk factors, Black patients were 1.8 times more likely and patients who spoke a primary language other than English were 1.6 times more likely than their counterparts to develop a CLABSI.

These results suggest that systemic racism and bias may play a role in inequitable hospital care for hospital-acquired infections. To address these disparities, hospital-wide quality improvement work aimed at reducing CLABSIs should stratify outcomes by race, ethnicity, and primary language to assess for disparities prior to implementing quality improvement efforts in order to inform QI interventions to improve equity.

Blumenthal also highlighted the 2022 update to the SHEA/IDSA/APIC Practice Recommendations for preventing healthcare-associated infections. The update focuses on insertion and maintenance of central lines. Blumenthal notes that most CLABSIs are not insertion related, but to minimize insertion related infections, the recommendations stress use of an insertion bundle, full sterile barriers, and formal CVC insertion training. The risk for CLABSIs is highest for short-term central venous catheters compared to ports. Thrombosis is also a major risk factor for infection.

Regarding maintenance bundles, the new updates recommend chlorhexidine impregnated dressings and cap protectors containing alcohol as essential practices. As each additional day that a CVC remains in place increases the risk of infection, daily rounding and surveillance tools should be used to evaluate the necessity of CVC regularly. Whenever feasible, IV medications should be transitioned to PO to minimize unnecessary catheter manipulation. Line surveillance programs are effective at identifying high-risk CVCs for further interventions and to remove unnecessary CVCs.

Reducing CLABSIs, Blumenthal reminds us, can be done by engaging, educating, executing, and evaluating; equitably.

Reference
Blumenthal J. Hot topics in diagnosing, preventing and treating central line associated bloodstream infections. ID Week 2023. October 13, 2023. Boston, Massachusetts.