IS COMPLIANCE ENOUGH?

CLASBI AND IT’S IMPORTANCE TO

HEALTH CARE PROFESSIONALS. 1

In 2012 a three year old girl, Nora Bostrom, lost her life because of a protocol change for the dressing of
her central line. The little girl developed a central line-associated infection due to the insufficiencies of
septic techniques during dressing changes. A central line-associated infection happens when pathogens
(bacteria, or viruses), enter the line and then enter into the blood stream. Nora was born prematurely, and
later diagnosed with Pulmonary Hypertension. Her hypertension became worse and she was put on a
central line catheter. While at the hospital simple protocol of washing hands and wearing masks was not
followed by nurses during dressing changes. Her death was preventable.

CLABSI statistics:
The typical cost for a CLABSI is $45,000.00.
In 2018 19,188 CLABSIs were reported.
Education: CLABSI Prevention-Ease of Compliance
Prevention checklist for CLABSI:
2
 Preform Hand Hygiene before insertion
 Adhere to aseptic technique
 Use maximal sterile barrier precautions (i.e., mask, cap, gown, sterile gloves, and
sterile full body drape).
 Choose best insertion site to minimize infections and noninfectious complications
based on individual patient characteristics: avoid femoral site in obese patients.
 Prepare the insertion site with >0.5% chlorhexidine with alcohol
 Place a sterile gauze dressing or a sterile, transparent, semipermeable dressing over
insertion site
 For patients 18 years or older, use chlorohexidine impregnanted dressing with an FDA
cleared label that specifies a clinical indication for reducing CLABSI for short term
non-tunneled catheters unless the facility is demonstrating success at preventing
CLABSI with baseline prevention practices
CLABSI Preventions

During Insertion of a Central Line 3

1.Hand hygiene by washing hands with soap and water or with alcohol-based gels or foams.
Gloves do not obviate the need for hand hygiene. 
2.Strict aseptic technique by using maximal sterile barrier precautions, including a full-body
drape when inserting central venous catheters.
3.Use of 2% chlorhexidine skin preparations for disinfecting/ cleaning skin before insertion.
4.Ultrasound guidance by an experienced provider for placement to circumvent mechanical
complications and reduce the number of attempts. 
5.Avoid the femoral vein as a choice for central line placement, and prefer the subclavian vein
when possible for non-tunneled catheters.
6.Promptly remove any central line that is no longer required.
7.Replace central lines placed during an emergency (asepsis not assured) as soon as possible or
at least within 48 hours. 
8.Use a checklist.

During Maintenance of a Central Line

1. Disinfect the catheter hubs, injection ports, and connections before accessing the
line.
2. Replace administration sets other than sets used for lipids or blood products every
96 hours.
3. Assess the need for the central line daily.
 Motivational quote for CLABSI- “CLABSI, 4
CLABSI, hand hygiene, CLABSI, CLABSI,
priority, CLABSI, CLABSI, sterility,
CLABSI, CLABSI, work with integrity!”

Centers for Disease Control and Prevention. (n.d.). Retrieved July 30, 2020, from https://www.cdc.gov/

Central Line-Associated Bloodstream Infections. (n.d.). Retrieved July 30, 2020, from https://arpsp.cdc.gov/profile/infections/CLABSI

Haddadin Y, Annamaraju P, Regunath H. Central Line Associated Blood Stream Infections (CLABSI) [Updated 2020 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430891/

Pat Parks, M. (n.d.). The positive ROI on CLABSI prevention interventions: Reducing hospital acquired infections (HAIs) remains an ongoing patient safety battle for health systems. Retrieved July 30, 2020,
from https://www.beckershospitalreview.com/quality/the-positive-roi-on-clabsi-prevention-interventions.html

Patient Story. (n.d.). Retrieved July 30, 2020, from https://patientsafetymovement.org/advocacy/patients-and-families/patient-stories/nora-bostrom