CLABSI

CLABSI is the medical abbreviation for central line-associated bloodstream infection. CLABSIs are a type of healthcare-associated infection (HAI). They occur when germs get into your bloodstream through a central line. Central lines are long, flexible tubes. Healthcare providers use them to give you medicine or fluids. They also use them to take blood samples.

Central lines aren’t the same thing as the shorter and thinner ones that go into your limbs (peripheral IVs). Providers place central lines into veins deep within your neck, chest, arm, belly or groin. They lead to a major vein close to your heart. Central lines are much more likely to cause infections. Types of central lines include:

• PICC: Providers insert this type of catheter into a vein in your upper arm and then guide it to your chest.
• Tunneled catheter: Providers place tunneled catheters into a vein in your chest or neck.
• Non-tunneled catheter: Providers insert non-tunneled catheters into a vein in your neck, groin or chest.
• Implanted port: Providers place ports under the skin in your chest, arm or belly. They provide easy access to a vein.

CLABSIs are serious infections that can lead to further complications, including death. In the U.S., about 250,000 CLABSI cases happen in hospitals every year. But central line-associated bloodstream infections are preventable. There are things you can do to keep yourself safe while you’re in the hospital.

What is the first symptom of a CLABSI?

You may not have any signs or symptoms of an infection. Your healthcare provider may discover it when they’re testing your blood for infection (culture). If you do have CLABSI symptoms, they may include:

• Fever
• Chills
• Redness or darker skin around the catheter insertion site
• Pain, soreness or swelling around the insertion site
• Discharge from the insertion site
• Trouble drawing blood
• Poor blood flow

What is the most common cause of CLABSIs?

Central line-associated bloodstream infections happen when bacteria or fungi enter your bloodstream through a central line. The most common germs that cause CLABSIs are:

• Staphylococci, 34.1%
• Enterococci, 16%
• Candida species, 11.8%
• Other, 10.5%
• Staphylococcus aureus, 9.9%
• Klebsiella, 5.8%
• Enterobacter, 3.9%
• Pseudomonas, 3.1%
• E. coli, 2.7%
• Acinetobacter, 2.2%

Risk factors

You’re more likely to develop a CLABSI if you have a long hospital stay before you get a central line. Or if healthcare providers have trouble getting to your veins. Your risk of central line-associated bloodstream infections also increases if you have certain health conditions. These include:

• Preterm birth
• Weakened immune system
• Neutropenia
• Burns
• Malnutrition
• BMI greater than 40

Complications of CLABSIs

A CLABSI can mean you have to have the central line removed. That can make it hard for you to receive the medications and fluids that you need. CLABSIs can cause severe complications, including:

• Antimicrobial-resistant infections
• Abnormal blood clotting
• Organ failure
• Septic shock
• Sepsis

Central line-associated bloodstream infections can also lead to other serious issues, like:

• Longer ICU stays (average of 24 days vs. five days if you don’t have a CLABSI)
• Longer overall hospital stays (average of 45 days vs. 11 days)
• Greater risk of death (51% vs. 28%)

How doctors diagnose CLABSIs

Your healthcare provider will ask you about your symptoms and perform a physical exam.

But the most accurate way to diagnose a CLABSI is with a blood culture. For this test, your provider draws blood from two areas: the central line and a peripheral line. They’ll label them and send them to a lab. At the lab, a pathologist will try to make germs in the sample grow and multiply. If the sample has enough bacteria, they’ll confirm an infection.

Your provider may also request other tests. These include:

• Complete blood count (CBC)
• Electrolyte panel
• Kidney function tests
• Liver function tests

How are CLABSIs treated?

The results of a blood culture can take several days to come back. But if your healthcare provider thinks you may have a central line-associated bloodstream infection, they won’t wait. They’ll base treatment on:

• The most likely cause
• Your symptoms
• Your overall health

Your provider will give you an antibiotic that can treat several types of bacterial infections. They’ll give you an antifungal if they think you may have a fungal infection.

Once the results come back, your provider will know the specific bacterium or fungus that’s causing the infection. At that point, they’ll treat you with a more targeted and appropriate medication.

What is the outlook (prognosis) for someone with a CLABSI?

CLABSIs have become more resistant to antibiotics. They’ve also become resistant to antifungals. That means medicine can’t stop the germs from growing and infecting your body. This can make the infection very hard for your provider to treat.

Unfortunately, sometimes providers can’t find a medication that will clear the infection. It may spread to other areas of your body. Or you may develop severe complications. About 28,000 people die from CLABSIs every year.

How can CLABSIs be prevented?

CLABSI prevention is possible. As a patient in the hospital, there are steps you can take to reduce your risk of an infection. These include:

• Speak up: Alert your healthcare provider if you think you have an infection. Also, tell them about any recent medical treatments. This includes time in other hospitals and/or outside the U.S.
• Ask questions: Ask your healthcare provider about the pros and cons of a central line. Ask when it will be removed. Also, ask them what they’re doing to protect you from antimicrobial-resistant infections.
• Follow treatment guidelines: If your provider gives you antibiotics, take them exactly as prescribed. Tell your provider about any side effects you develop.
• Don’t touch: Try not to touch the catheter and the area around the insertion site.
• Wash hands: Make sure anyone who enters your room (healthcare providers and visitors) washes their hands often.
• Get your room cleaned: Let hospital staff clean your room. This can help eliminate germs and reduce the chances of an infection.

What are the five elements of the CLABSI bundle?

Preventing central line-associated bloodstream infections starts with your healthcare providers. They may use a system called the CLABSI bundle. If so, you can confirm they’re following all of these evidence-based practices to prevent infection. The five elements of the CLABSI bundle are:

• Hand hygiene. Your provider should wash their hands before they insert a central line.
• Maximal barrier precautions. Your provider should wear personal protective equipment when inserting a central line. That may include a surgical cap and mask, sterile gloves and a gown.
• Chlorhexidine skin antisepsis. Before inserting a central line, your provider should clean and disinfect your skin with an antiseptic called chlorhexidine.
• Optimal catheter site selection. Your provider should choose an appropriate vein for inserting a central line. In adults, they should avoid the femoral vein.
• Daily review of catheter necessity. Your provider should question the need for a central line daily. They should remove it as soon as it’s no longer needed.