Minimize Risk of CLABSI

The public health burden associated with hospital-acquired infections is substantial and includes increased morbidity and mortality, increased length of hospital stay, and increased costs. It is well known that CRBSIs are associated with increased morbidity and mortality.

Raad et al published an attributable mortality rate of 12% to 25% in the critical care patient population that experiences catheter-related bacteremia,2 and the CDC has estimated approximately 71,900 CLABSIs occur in the US each year.1 The excess costs associated with each incidence of CLABSI ranges up to $46,685.3 Additional estimates place the total economic burden of CLABSIs in the US at approximately $2 billion.10

Common CLABSI-Related Questions

How often do CLABSIs occur?

  • The CDC has estimated that approximately 71,900 CLABSIs occur in the US each year1
  • 12 – 25% of CRBSIs will result in infection-attributable death2

What is the cost of CLABSI?

  • Incremental cost per episode of CRBSI ranges up to $46,6853

How do Catheter-Related Bloodstream Infections Develop?

  • The development of CRBSI takes place by contamination of the catheter in 1 of 4 separate ways either intraluminally or extraluminally, with the majority being extraluminal. 4
    • “Migration of skin organisms at the insertion site into the cutaneous catheter tract and along the surface of the catheter with colonization of the tip
    • Direct contamination of the catheter or hub by hand contact or contaminated fluids/devices
    • Hematogenous seeding from another focus of infection
    • Infusate contamination (rare)”

What are the risk factors for CLABSI?

  • Dressing Disruptions Happen Frequently and Contribute to Increased CRBSI
    • Evidence indicates that 67% of CVC dressing changes were performed prematurely, before the planned date.5
    • Risk of CRBSI increased by more than 3-fold after the second dressing disruption and more than 12-fold after the final dressing disruption.5
    • A study found that 4 commercially available central venous catheter dressings had surprisingly limited durability. A total of 75% of the dressings lasted less than 48 hours, and only 3% of dressings lasted a full 7 days.6

What evidence-based recommendations exist to provide guidance on the care and maintenance of vascular catheters to prevent infections?

  • Clinical best practices guidelines from the CDC recommend:7
    • Replacement of catheter site dressing if the dressing becomes damp, loosened, or visibly soiled
    • Replacement of dressings used on short-term CVC sites at least every 7 days

CDC Logo

  • The Infusion Therapy Standards of Practice list the following dressing change recommendations:8Infusion Therapy Standards of Practice cover image
    • Change transparent semipermeable membrane dressings at least every 5 to 7 days
    • Dressing changes are performed immediately if the dressing becomes damp, loosened for visibly spoiled
    • Secure the dressings to reduce the risk of loosening/dislodgement, as more frequent dressing changes due to dislodgement are associated with increased risk for infection

What can be done to minimize risk of vascular access device (VAD) dressing disruption?

  • Gum mastic liquid medical adhesive can help caregivers adhere to best-practice recommendations by preventing the loosening of dressings for up to 7 days, which may prevent catheter insertion-site exposure and catheter dislodgement.
  • A dressing bundle with gum mastic and adhesive remover was implemented at a Methodist facility in 2017 to improve dressing integrity. Over 20,000 intravenous sites were assessed. The authors report dressing integrity was improved, with less than 2% of site having the insertion site exposed.  There was no reported increase in medical adhesive related skin injury.9

How can I find out the rate of dressing adherence at my facility and to ensure compliance with evidence-based guidelines for dressing care and maintenance?

  • The loss of vascular access device dressing adherence exposing the insertion site is an often overlooked and unattended occurrence, which increases the risk of CRBSI.5
  • Request a Vascular Access Dressing Adherence Point Prevalence Assessment from Eloquest Healthcare here.
  1. Magill SS, Edwards JR, Bamberg W, et al. Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014; 370(13): 1198-208.
  2. Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007 Oct; 7(10):645-57. PMID: 17897607.
  3. Nelson RE, Angelovic AW, Nelson SD, Gleed JR, Drews FA. An economic analysis of adherence engineering to improve use of best practices during central line maintenance procedures. Infect Control Hosp Epidemiol. 2015 May; 36(5): 550-6.
  4. Safdar N, Maki DG. The Pathogenesis of Catheter-Related Bloodstream Infection with Noncuffed Short-term Central Venous Catheters. Int Care Med. 2004; 30:62-7.
  5. Timsit J, et al. Dressing disruption is a major risk factor for catheter-related infections.  Crit Care Med.  2012; 40(6): 1707-1714.
  6. Richardson A, et al. Central venous catheter dressing durability: an evaluation. Journal of Infection Prevention.  2015; 16(6):  256–261.
  7. O’Grady NP, et al. Healthcare Infection Control Practices Advisory Committee: Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011.
  8. Infusion Nurses Society. Infusion therapy standards of practice. J Infusion Nursing 2016;39(1S):S1-159.
  9. DeVries M, et al. Post Implementation Monitoring Following Introduction of Gum Mastic Liquid Adhesive for Vascular Access Dressings. Presented at AVA Annual Scientific Meeting, Columbus, OH, September 2018.
  10. Herzer KR, Niessen L, Constenla DO, Ward WJ Jr, Pronovost PJ. Cost-effectiveness of a quality improvement programme to reduce central line associated bloodstream infections in intensive care units in the USA. BMJ Open. 2014 Sep; 4(9): e006065. doi: 10.1136/bmjopen-2014-006065.