Hospital acquired infections are referred to as nosocomial infections. They are costly and typically can be avoided. Central line infections are no exception. Central line infections are mostly acquired in the hospital since patients aren’t usually discharged with a central line. The national patient safety goal NPSG. 07. 04. 01 is to implement evidence-based practices to prevent central line-associated bloodstream infections. This requirement covers short- and long-term central venous catheters and peripherally inserted central catheter lines.
New guidelines regarding central line infections have been established for health care facilities to execute based on the most recent findings and statistics. The average payment for a patient who developed a central line-associated bloodstream infection (CLAB) is $68,894, but the actual average cost of treating the patient was $91,733, leading to a gross loss of $26,839 per case. In 2009, an estimated 23,000 central line associated blood stream infections (CLABSI) occurred among patients in inpatient wards and, in 2008, an estimated 37,000 CLABSIs occurred among patients receiving outpatient hemodialysis.
If for every one of those cases the average cost was $26,839, the total would be over 600 billion dollars a year. Of course, this is nationwide figure that is spread over every hospital on the census. However, it is still shocking. That is 600 billion dollars theses hospitals lose every year. One thing learned in economics is that an amount that large affects one and all. If a hospital loses more money than it can make, it will shut down, simple as that. Before it does however, the hospital will struggle to stay open and do so however it can.
This could mean the cutting of wages or laying off employees. Or turning patients away that do not have adequate insurance. Bottom line, corners will be cut to compensate the loss. Anytime corners are cut, the safety of the patients is jeopardized. Cutting corners is usually the reason patients get central line infections initially. When a health care facility is short staffed and one nurse is doing the job of possibly two or three nurses, guidelines and protocols become more difficult to follow. Every six hour central line flushes are hard to comply with when a nurse might have seven patients.
It is very possible that half if not all of those seven patients have central lines or PIVs that all require flushes every six hours. Dressing changes on the central lines can exacerbate the problem as well, especially if the dressings aren’t dated with a marker or pen. Patients seldom have the dressing change on the same date, so a the short staffed nurse would have to check daily when each central line dressing is due to be changed if they are not marked correctly. Although the disposition of this paper has been less than positive, central line infections are far better today than they were ten years ago.
In fact, central line infections have gone down by 58% from 2001 to 2009. This is a long stride in the right direction. However, there is always room for improvement. The CDC recognizes these statistics and the concern for patients’ health and set forth a set of guidelines that are evidence-based to help with the prevention of central line infections. The official document that the CDC published is very elaborate and daunting. For sake of the reader, only a portion of the CDC document will be discussed.
This paper does not encompass everything the CDC addresses and only the most notable aspects of the document have been extracted and are as follows: * Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled * Replace dressings used on short-term CVC sites every 2 days for gauze dressings. * Replace dressings used on short-term CVC sites at least every 7 days for transparent dressings * Monitor the catheter sites visually when changing the dressing or by palpation through an intact dressing on a regular basis, depending on the clinical situation of the individual patient. Encourage patients to report any changes in their catheter site or any new discomfort to their provider * Do not routinely use anticoagulant therapy to reduce the risk of catheter-related infection in general patient populations * Do not routinely replace CVCs, PICCs, hemodialysis catheters, or pulmonary artery catheters to prevent catheter-related infections. * clinicians shall use an aseptic technique including cleaning the access port(s) with a single-use 70% alcohol-impregnated swab and allowing to dry prior to accessing the system My experience has been that the health care teams at St Mary’s implement these guidelines attentively.
Only a few occurrences come to mind that did not comply with these guidelines. I have also witnessed some central line dressing being visibly loose and soiled but I am unsure if they were like that long or if they were about to be changed. I just saw them in passing. I have also seen numerous central lines being flushed with heparin. If a central line becomes clogged, then a new line will have to be put in. Flushing central lines with an anticoagulant like heparin, reduces the chances of the line clogging and decreases the likelihood of having to start a new line.
Flushing with heparin carries the risk of giving a patient a small dose of heparin that may not be needed and increase the risk of bleeding. The CDC determined that the risk of bleeding outweighed the risk of clogged lines and thus the protocol of not flushing with heparin was set forth in the new guidelines. I could not find any numbers that supported the CDC’s reasoning. I would think that ensuring a clear catheter would minimize infections because less central lines would have to be put in because of a clog.
Every new central line placed is a new chance of infection. Central lines vary in length, so consequently, the amount of fluid it takes to flush a line varies. This unavoidable element increases the chances of giving a patient an unwanted heparin dose. It is my belief that if more evidence based practice was performed; flushing with heparin could be brought to a new safe level. If the length of every central line was known, and the amount of fluid that would occupy that line was known, only a small fraction of heparin would ever get into the patient.
McLaws, M. , & Burrell, A. (2012). Zero risk for central line-associated bloodstream infection:Are we there yet? *. Critical Care Medicine, 40(2), 388-393. Miller, S. , & Maragakis, L. (2012). Central line-associated bloodstream infection prevention. Current Opinion In Infectious Diseases, 25(4), 412-422. Vital signs: central line–associated blood stream infections — United States, 2001, 2008, and2009. (2011). MMWR: Morbidity & Mortality Weekly Report, 60(8), 243-248.