References

Ho C, Spry C. Central venous access devices (CVADs) and peripherally inserted central catheters (PICCs) for adult and pediatric patients: a review of clinical effectiveness and safety.Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017

Smith RN, Nolan JP. Central venous catheters. BMJ. 2013; 347 https://doi.org/10.1136/bmj.f6570

Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2015; 43:(1)29-36 https://doi.org/10.1007/s15010-014-0689-y

Central line associated blood stream infections. https//pubmed.ncbi.nlm.nih.gov/28613641/ (Accessed September 17, 2022)

NHSN. Bloodstream infection event (central line-associated bloodstream infection and non-central line associated bloodstream infection). https//www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf (Accessed September 17, 2022)

Hsu HE, Mathew R, Wang R Health care-associated infections among critically ill children in the US, 2013–2018. JAMA Pediatr. 2020; 174:(12)1176-1183 https://doi.org/10.1001/jamapediatrics.2020.3223

Hightower HB, Young JA, Thomas J Reduction of central-line–associated bloodstream infections in a tertiary neonatal intensive care unit through simulation education. Pediatr Qual Saf. 2022; 7:(6) https://doi.org/10.1097/pq9.0000000000000610

Milstone AM, Reich NG, Advani S Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013; 132:(6)e1609-e1615 https://doi.org/10.1542/peds.2013-1645

Szydlowski EG, Rudolph JA, Vitale MA, Zuckerbraun NS. Bloodstream infections in patients with intestinal failure presenting to a pediatric emergency department with fever and a central line. Pediatr Emerg Care. 2017; 33:(12)e140-e145 https://doi.org/10.1097/PEC.0000000000000812

Venturini E, Montagnani C, Benni A Central-line associated bloodstream infections in a tertiary care children's university hospital: a prospective study. BMC Infect Dis. 2016; 16:(1) https://doi.org/10.1186/s12879-016-2061-6

Centers for Disease Control and Prevention. Healthcare associated infections—impact of COVID-19 on HAIs. https//www.cdc.gov/hai/data/portal/covid-impact-hai.html (Accessed October 12, 2022)

Chamblee TB, Patton LJ, Young VB, Marusich J, Bowens CD, Miles DK. Reducing central line-associated bloodstream infection in contaminated central venous catheters: case studies of a pediatric contamination guideline. Br J Nurs. 2021; 30:(19)S24-S29 https://doi.org/10.12968/bjon.2021.30.19.S24

Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011; 32:(2)101-114 https://doi.org/10.1086/657912

Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated blood-stream infections. Pediatrics. 2014; 133:(6)e1525-e1532 https://doi.org/10.1542/peds.2013-3795

Schulman J, Stricof R, Stevens TP Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics. 2011; 127:(3)436-444 https://doi.org/10.1542/peds.2010-2873

McCarron K. Understanding care bundles. Nurs Made Incred Easy J. 2011; 9:(2)30-33 https://doi.org/10.1097/01.NME.0000394024.85792.42

Pogorzelska-Maziarz M. The use and effectiveness of bundles for prevention of central line-associated bloodstream infections in neonates: a review of the literature. J Perinat Neonatal Nurs. 2016; 30:(2)148-159 https://doi.org/10.1097/JPN.0000000000000171

Wei AE, Markert RJ, Connelly C, Polenakovik H. Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle. J Infect Prev. 2021; 22:(5)186-193 https://doi.org/10.1177/17571774211012471

Gupta P, Thomas M, Patel A Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit. BMJ Open Qual. 2021; 10:(1) https://doi.org/10.1136/bmjoq-2020-001200

Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis. 1993; 168:400-407

O'Grady NP, Alexander M, Burns LA Healthcare Infection Control Practices Advisory Committee Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011; 1-34

Kaler W. Making it easy for nurses to reduce the risk of CLABSI. Patient Saf Qual Healthc. 2014; 11:(6)46-49

Akridge J. Infection prevention efforts as varied as infections. Healthcare Purchasing News. 2013; 34:(7)

Rinke ML, Milstone AM, Chen AR Ambulatory pediatric oncology CLABSIs: epidemiology and risk factors. Pediatr Blood Cancer. 2013; 60:(11)1882-1889 https://doi.org/10.1002/pbc.24677

Buetti N, Marschall J, Drees M Strategies to prevent central line-associated bloodstream infections in acutecare hospitals: 2022 update. Infect Control Hosp Epidemiol. 2022; 43:(5)553-569 https://doi.org/10.1017/ice.2022.87

Ostroff M, Zauk A, Chowdhury S, Moureau N, Mobley C. A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: a low risk central venous access approach in the neonatal intensive care unit. J Vasc Access. 2021; 22:(6)926-934 https://doi.org/10.1177/1129729820969291

Fisher D, Cochran KM, Provost LP Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics. 2013; 132:(6)e1664-e1671 https://doi.org/10.1542/peds.2013-2000

Trautner BW, Darouiche RO. Catheter-associated infections: pathogenesis affects prevention. Arch Intern Med. 2004; 164:(8)842-850 https://doi.org/10.1001/archinte.164.8.842

Salzman MB, Rubin LG. Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections. Nutrition. 1997; 13:15S-17S https://doi.org/10.1016/s0899-9007(97)00217-7

Moureau NL, Flynn J. Disinfection of needleless connector hubs: clinical evidence systematic review. Nurs Res Pract. 2015; 2015 https://doi.org/10.1155/2015/796762

Jarvis WR, Murphy C, Hall KK Health care-associated bloodstream infections associated with negativeor positive-pressure or displacement mechanical valve needleless connectors. Clin Infect Dis. 2009; 49:(12)1821-1827 https://doi.org/10.1086/648418

Perez E, Williams M, Jacob JT Microbial biofilms on needleless connectors for central venous catheters: comparison of standard and silver-coated devices collected from patients in an acute care hospital. J Clin Microbiol. 2014; 52:(3)823-831 https://doi.org/10.1128/JCM.02220-13

Rickard CM, Flynn J, Larsen E Needleless connector decontamination for prevention of central venous access device infection: a pilot randomized controlled trial. Am J Infect Control. 2021; 49:(2)269-273 https://doi.org/10.1016/j.ajic.2020.07.026

Merrill KC, Sumner S, Linford L, Taylor C, Macintosh C. Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. Am J Infect Control. 2014; 42:(12)1274-1277 https://doi.org/10.1016/j.ajic.2014.09.008

Simmons S, Bryson C, Porter S. “Scrub the hub”: cleaning duration and reduction in bacterial load on central venous catheters. Crit Care Nurs Q. 2011; 34:(1)31-35 https://doi.org/10.1097/CNQ.0b013e3182048073

Wright MO, Tropp J, Schora DM Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control. 2013; 41:(1)33-38 https://doi.org/10.1016/j.ajic.2012.05.030

Voor in 't Holt AF, Helder OK, Vos MC Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: a systematic review and meta-analysis. Int J Nurs Stud. 2017; 69:34-40 https://doi.org/10.1016/j.ijnurstu.2017.01.007

Forbes-Penfold D, Pearson A, Hughes A, Koeglmeier J, Hill S, Evans V. Reducing central venous lines [CVL] infections within the home parental nutrition [HPN] patient group by using Parafilm®. Clin Nutr ESPEN. 2015; 10:(5) https://doi.org/10.1016/j.clnesp.2015.03.075

Stenger EO, Newton JG, Leong T Application of Parafilm as a physical barrier on CVC connections is feasible and may reduce CLABSI among pediatric HCT patients. Biol Blood Marrow Tr. 2019; 25:(3) https://doi.org/10.1016/j.bbmt.2018.12.41

Nickel B. Hiding in plain sight: peripheral intravenous catheter infections. Crit Care Nurse. 2020; 40:(5)57-66 https://doi.org/10.4037/ccn2020439

Vascular Access/IV

Guarding the central venous access device: a new solution for an old problem

26 October 2023
Association for Vascular Access
02 October 2023
Volume 32 · Issue 19

Abstract

HIGHLIGHTS

CLABSIs are a major concern in both the adult and pediatric patient population.

Contamination of catheter hubs is a common cause of CLABSI.

A novel, transparent line guard protects CVAD hubs from gross contamination.

Central line-associated blood stream infections (CLABSIs) are a serious and potentially deadly complication in patients with a central venous access device (CVAD). CVADs play an essential role in modern medicine, serving as lifelines for many patients. To maintain safe and stable venous access, infection prevention bundles are used to help protect patients from complications such as CLABSI. Despite most CLABSIs being preventable, rates have been on the rise, often disproportionately impacting critically ill children. New solutions are needed to strengthen infection prevention bundles and protect CVADs from pathogen entry at catheter hubs and line connections. A novel, Food and Drug Administration–listed device has become available recently to guard CVADs from sources of gross contamination, addressing this apparent gap in infection prevention technology and practice.

A central venous access device (CVAD) is a type of intravenous catheter commonly used for administering fluids, parenteral nutrition, medications, antibiotics, and blood products. These types of catheters are common in both inpatient and outpatient care and may be used for short-to long-term therapies. Unlike peripheral intravenous (PIV) catheters, which extend only a short distance within the vasculature, CVADs terminate in the superior or inferior vena cava and can stay in place for longer durations. For many diagnoses, CVADs are considered lifelines.1,2

A known risk factor of CVADs are central line-associated bloodstream infections (CLABSIs), a major cause of morbidity and mortality.3 CLABSI is defined as a laboratory-confirmed bloodstream infection with a CVAD in place greater than 2 days and not related to an infection at another body site.4 It is estimated that one-third of the deaths caused by hospital-acquired infections are a result of CLABSI, and the National Healthcare Safety Network reported that an estimated 30,100 CLABSIs occur in United States acute care facilities each year.5

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

Register
Or continue by

Signing in with your registered email address

central line-associated blood stream infections
pediatrics
central venous access
infection prevention
catheter contamination