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CLABSI Toolkit - Introduction

Central Line-Associated Bloodstream Infection Introduction

The monograph introduction discusses the health care-associated infections (HAIs) problem, imperatives for the elimination of HAIs, background on central line-associated bloodstream infection (CLABSI) terminology, CLABSI-related morbidity and mortality costs, and the preventability of CLABSIs. Key points include the following:

  • HAIs occur throughout the world, affecting hundreds of millions of patients each year.These infections are not only costly to individuals and health care systems; they can significantly increase morbidity and mortality in developed countries2 and in developing countries.3,4

  • There is growing recognition that many HAIs are largely preventable when evidence-based practices are followed consistently over time.

  • Central venous catheters (CVCs) are the most frequent cause of health care-associated bloodstream infections.5

    • CVCs play an integral role in modern health care, allowing for the administration of intravenous fluids, blood products, medications, and parenteral nutrition, as well as providing hemodialysis access and hemodynamic monitoring; their use, however, is associated with a risk of bloodstream infection caused by microorganisms colonizing the external surface of the device or the fluid pathway when the device is inserted or in the course of its use.6

  • Throughout the toolkit and monograph, the term used for intravascular catheter-related infections is CLABSI. Two terms, used to describe intravascular catheter-related infections, central line–associated bloodstream infection (CLABSI) and catheter-related bloodstream infection (CRBSI)should be distinguished in the following way7,8:

    • CLABSI is the term used by the US Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN)(see NHSN CLABSI information).  A CLABSI is a primary bloodstream infection (that is, there is no apparent infection at another site) that develops in a patient with a central line in place within the 48-hour period before onset of the bloodstream infection that is not related to infection at another site. Culturing the catheter tip or peripheral blood is not a criterion for CLABSI.

    • CRBSI is a more rigorous diagnostic definition and requires specific laboratory testing to identify the catheter as the source of the bloodstream infection, such as culturing the catheter tip or a more elaborate method such as differential time-to-positivity of blood cultures.

  • Employing relatively simple evidence-based practices to reduce, if not eliminate, CLABSIs appears to be within the reach of even resource-limited settings.10 Within this framework, HAIs — and CLABSIs in particular — are more and more being viewed as “preventable events" 

  1. World Health Organization. Report on the Endemic Burden of Health Care–Associated Infection Worldwide; A Systematic Review of the Literature. Allegranzi B, et al. 2011. Accessed Apr 15, 2013.
  2. Burke JP. Infection control—A problem for patient safety. N Engl J Med. 2003 Feb 13;348(7):651–656.
  3. Rosenthal VD, et al. The attributable cost, length of hospital stay, and mortality of central line–associated bloodstream infection in intensive care departments in Argentina: A prospective, matched analysis. Am J Infect Control. 2003 Dec;31(8):475–480.
  4. Higuera F, et al. Attributable cost and length of stay for patients with central venous catheter–associated bloodstream infection in Mexico City intensive care units: A prospective, matched analysis. Infect Control Hosp Epidemiol. 2007 Jan;28(1):31–35.
  5. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: A systematic review of 200 published prospective studies. Mayo Clin Proc. 2006 Sep;81(9):1159–1171.
  6. Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis. 2011 Jan 15;52(2):211–212.
  7. O’Grady NP, et al.; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011 May;52(9):e162–193. Epub 2011 Apr 1.
  8. Tomlinson D, et al. Defining bloodstream infections related to central venous catheters in patients with cancer: A systematic review. Clin Infect Dis. 2011 Oct;53(7):697–710.
  9. US Centers for Disease Control and Prevention, National Healthcare Safety Network. Device-Associated (DA) Module. Protocol and Instructions: Central Line–Associated Bloodstream Infection (CLABSI) Event. Jan 2012.
  10. Apisarnthanarak A, et al. Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: A 3-year study. Am J Infect Control. 2010 Aug;38(6):449–455.