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Central Line-Associated Primary Bloodstream Infection

Definition

When a patient requires long-term access to medication or fluids through an IV, a central line is put in place. A central line-associated primary bloodstream infection (CLI) can occur when bacteria and/or fungi enter the blood stream, causing a patient to become sick. The bacteria can come from a variety of places such as skin wounds or the environment, though most often come from the patient's skin.
 
Performance

North York General Hospital regularly monitors and reviews infection rates and uses this information to execute best practice protective measures and continually improve patient care and safety. All hospitals with Intensive care units are required to report into the Critical Care Information System — a centralized data collection system where hospitals report a variety of critical care information — must publicly report the CLI indicator data. This includes North York General. Hospitals post their quarterly CLI rate and case count for those infections acquired in their facility, using the following formula:

total # of ICU-related bloodstream infections after 48 hours of central line placement X 1000
total # of central line days for ICU patients 18 years and older

What we are doing to improve patient safety

Patient safety remains the most important priority for North York General and this involves ensuring that patients are not at risk for contracting health care-associated infections. We have a number of practices in place to help prevent and control infections. North York General is improving patient safety in a number of ways including:
 
  • Adopting and executing Canadian Patient Safety Institute practices to prevent CLI infections and their adverse effects
  • Developing a comprehensive system for screening and surveillance of high-risk patients for infectious syndromes (e.g. diarrhea, meningitis, etc.) and antibiotic-resistant organisms (Methicillin-resistant Staphylococcus aureus or MRSA, vancomycin-resistant enterococci or VRE, C. difficile, etc.)
  • Enhancing our Infection Prevention and Control Program
  • Actively implementing an aggressive hand washing campaign across the entire hospital to dramatically increase hand washing compliance rates
  • Engaging North York General staff in developing plans to respond to pandemic influenza

Frequently asked questions

What are health care-associated infections?
Sometimes when patients are admitted to the hospital, they can get infections. These are called health care-associated infections.
 
What is a Central-Line Associated Blood Stream Infection?
When a patient requires long-term access to medication or fluids through an IV, a central line is put in place. A central line blood stream infection can occur when bacteria and/or fungi enters the blood stream, causing a patient to become sick. The bacteria can come from a variety of places (e.g. skin, wounds, environment, etc.), though it most often comes from the patient's skin. Hospitals follow best practices on how to prevent bacteria from entering into a central line. Patients in the ICU often require a central line since they are seriously ill, and will require a lot of medication, for a long period of time.

What are the symptoms of CLI?
• Redness, pain or swelling at or near the catheter site
• Pain or tenderness along the path of the catheter
• Drainage from the skin around the catheter
• Sudden fever or chills
 
What are the risk factors for CLI?
Anyone who has a central line can get an infection. The risk is higher if you:
• Are in the intensive care unit (ICU)
• Have a serious underlying illness or debilitation
• Are receiving bone marrow or chemotherapy
• Have the line in for an extended time.
 
How do we treat CLI?
If a CLI is suspected, the central line is often removed and sent to the laboratory for testing. Once a diagnosis of CLI is confirmed, the patient may be treated with one or more antibiotics.
 
What do we do to prevent CLI?
CLIs account for 90% of catheter-related infections. Prevention interventions, such as the use of insertion and maintenance bundles can decrease infection rates.North York General Hospital's Critical Care Unit (CrCU) utilizes insertion bundles for all new central lines inserted in the CrCU. Insertion bundles encompass four aspects:
  1. optimal catheter site selection where there is a lower risk of infection
  2. aggressive hand hygiene habits
  3. the use of chlorhexidine 2% with 70% alcohol skin antiseptic
  4. maximum barrier precautions by all staff involved with the catheter insertion including wearing a cap, mask, gown and gloves.

Once a central line is in place, staff complete a maintenance bundle on a daily basis to determine whether the patient still requires the central line and whether there are any signs and symptoms of infection that would warrant early removal.

What can patients do to help reduce their chances of infection?
Patients should always follow instructions given to them by your health care team. Frequent hand cleaning is another way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.