Central Line Acquired Bloodstream Infection
Introduction
Central line acquired bloodstream infections have been a source of deaths running into thousands each year. Despite the fact that a lot of funds have been channeled towards ensuring that lives are saved, this killer infection keeps on claiming lives of many yet it is very preventable (Valencia, Hammami and Agodi et. al. 2016). Most of the deaths come as a result of germs gaining access to the bloodstream through the openings made while inserting the tubes into a patient, a practice that is common in intensive care units. The Intensive Care Unit is mostly affected because of the requirement to make quick effective administration of drugs and fluids to help a patient regain his or her health or survival chances. In order to stabilize a patient, a tube is always inserted into the patients’ blood vessel. Instead of increasing the chances of saving a life, the catheters inserted into the patients, because of failure to observe some medical pre-cautionary measures, these catheters turn out to be the major catalysts for deaths in hospitals (Valencia, Hammami and Agodi et. al. 2016). Majority of the infections related to the central-line bloodstream are caused by several factors such as being on the catheter for longer periods of time, the accumulation of microbial at the point where the tubes are inserted, patients getting less attention from nurses because of the high numbers of patients per nurse among other factors. However, despite the risks involved, it is believed that there are mechanisms through which these deaths caused by CLABSI could be averted hence save lives (Valencia, Hammami and Agodi et. al. 2016). Some of the methods that could be used to prevent infections include taking safety measures before inserting the catheter, when inserting the catheter, during the time when the catheter is in use and after the catheter has been used. For instance, before insertion, the health practitioner needs to have all the recent training on insertion of the CVC’s. Further, during insertion, a well-trained doctor has to be present to ensure the process does not proceed if faulty, and lastly, after insertion to ensure proper observation is in progress (Yokoe, Anderson and Berenholtz et al. 2014).
Statement Of The Problem
The term hospital is synonymous with the phrase “life saver.” Everyone who visits a hospital, or who takes his colleague to a hospital, does so with the hope that his or her friends life would be saved. However, as it turns out, hospitals could be death havens if certain basics are not observed. As such, the intensive care units have become more associated with deaths due to CLABSIs than saving the lives through their means of administration of drugs and other fluid, CVCs.
Statistics point out that more people die yearly in Intensive Care Units and hospital sections that majorly use catheters to give medication than in other hospital sections. The main cause of these deaths is infections related to the central line acquired bloodstream. What then, could be the reasons why people die of infections from hospitals that are meant to save their lives? The answer to this could be that the deaths are caused by the failure to observe or use the catheters and other tubes used to administer medication through the bloodstream in a professional manner or with the necessary precautions (Valencia, Hammami and Agodi et. al. 2016). The issue is not with the disinfection hubs, the catheters, the needleless connectors or the ports used for injection, but with the healthcare personnel.
The failure to observe certain procedural steps results in the infections that ultimately lead to deaths of thousands of patients yearly. Further, there seems to be no proper training on the best steps to use catheters by majority of the health practitioners (Valencia, Hammami and Agodi et. al. 2016). This could be explained by the fact that, most research on the causes suggests that there should be proper education and training for these deaths to be averted. Additionally, there are very few nurses allocated to patients in hospitals and this makes it hard for, for instance, one nurse to observe more than ten patients who are in critical conditions (Alonso-Echanove, Edwards, and Richards et al, 2003). Therefore, it is the purpose of this study to establish that the problem is on health practitioners training and education and the nurse to patient ratio disparities that lead to most of the central line acquired bloodstream infections and deaths in our hospitals.
Research Methodology
To arrive at the intended results, this study would be based on a desk-research. It shall be completely reliant on the available online sources, both primary and secondary for information. This information shall be collected from the internet and would include journals, articles, books and reports on the subject including a number of case studies on the same.
Literature review,
It is not news that CLABSIs, though preventable, are the main causes of deaths in Intensive Care Units worldwide. Research shows that these infections and deaths could be avoided if health practitioners take precautions before Central line insertions, during central line insertions and after central line insertions (Valencia, Hammami and Agodi et. al. 2016). It would be important to for instance, refrain from touching the femoral vein; to observe best practices during the Central line maintenance and also offering frequent assessment to the patient. Keenness when attending to patients on a central line would further help a health care specialist to detect when there is an unnecessary process. This has been found to be effective in reducing chances of CLABSIs hence reduce deaths.
However, because of difference in training, it is noted that in countries with high income, patients are more likely to survive deaths due to CLABSIs than in low income countries (Valencia, Hammami and Agodi et. al. 2016). This is so because developed countries have developed guidelines on administering central lines and also their health workers are highly trained than their counterparts in developing countries. It is also possible that because of lack of daily adherence to prevention practices that are evidence-based makes it an uphill task to reduce the CLABSIs (Rosenthal, 2009).
Almost every country is aware of the CLABSI menace in the medical world. There is however, minimal compliance with the commonly recommended practices for instance prophylaxis of the antimicrobial during the point of central line insertion especially in middle income states (Valencia, Hammami, and Agodi, et al. 2016). Patients are rarely covered with the sterile drapes. Similarly, they are rarely pre-treated with chlorohexidine before their skins are penetrated. Further, often, there is no prior consideration of whether the central line is necessary or not. Further, it is reported that despite there being measures in place, very few hospitals make follow up to ensure that the measures are implemented (Gonzales, Rocher, Fortin, et al. 2013). This places the blame on health practitioners for failing to adhere to evidence-based practices.
If at all it were the patients’ mistake, the deaths would not be as high as most patients depend on the directions of their doctors and medical caretakers. As such, this places the nurses and the medical fraternity personnel on the spotlight for the infections and deaths in Intensive care units (Valencia, Hammami, Agodi et al.2016). Additionally, almost every hospital or country rather, is aware of the dangers of the CLABSIs meaning that guidelines are put in place to ensure that the safety and health of patients is guaranteed. What then, other than negligence and utmost carelessness by the nurses and other players, could be the major cause of these infections and deaths?
To add on the foregoing, while failure to observe preventive procedures during central line insertions may be the main contributor to deaths due to CLABSI, it is also reported that the number of patients allocated to each nurse is also one of the causes of these killer infections (Alonso-Echanove, Edwards, and Richards et al, 2003). Most nurses are over-whelmed by the workload placed on their shoulders hence they are easily worn out resulting in less patient observation. It is further suggested that the ration of nurse to patient be improved to ensure that every patient in the intensive care unit receives the attention commensurate to the dangers they are exposed to in the ICU. As Cimiotti, Aiken and Evan et al (2012) argue, there is a co-relation between nurses being overworked and the infections reported in hospitals, in this case, Pennsylvania. The study found out that when the nurses’ workload was increased by one patient, there was an upward trend in the infections in the urinary tract and central line areas. Additionally, a difference in the nurses’ exhaustion also showed a difference in infections. For instance a rise in nurses’ burnouts by about ten percent led to an increase in infections to about one person per one thousand patients (Cimiotti, Aiken and Evan et al. 2012).
From the above, it is evident that central line acquired infections can be attributed to two factors. These are on one hand the medical practitioners (nurses’ et al) ignorance and on the other hand the failure to staff the hospitals well to ensure that there is a proper nurse per patient ratio. Because of failure on the healthcare providers to take necessary preventive measures when dealing with central line insertions, infections related to bloodstream keep on causing patient deaths worldwide. Further, because of inadequate staffing, nurses end up being exhausted hence lack the ability to observe patients properly.
References
Alonso-Echanove, J., Edwards, J.R. and Richards, M.J. et al. (2003) Effect of Nurse staffing and antimicrobial-impregnated central venous catheters on the risk for blood stream infections in intensive care units. Infect Control Hosp Epidomiol. 2003. Vol. 24. Pages 916-925.
Cimiotti, J.P. And Aiken, L.H. Et Al (2012). Nurse Staffing, Burnout, And Health Care-Associated Infection. Am J Infect Control. 2012. Vol. 40. (6):486-490. Doi:10.1016/j.ajic.2012.02.029
Gonzales M, Rocher I, Fortin É, et al. (2013). A Survey Of Preventive Measures Used And Their Impact On Central Line-Associated Bloodstream Infections (CLABSI) In Intensive Care Units (SPIN-BACC). BMC Infect Dis. 2013; 13:562. DOI: 10.1186/1471-2334-13-562.
Rosenthal VD. (2009). Central Line-Associated Bloodstream Infections in Limited-Resource Countries: A Review of the Literature. Clin Infect Dis. 2009; 49:1899–907. DOI:10.1086/648439.
Valencia, C., Hammami, N. And Agodi, A., Et Al. (2016). Poor Adherence To Guidelines For Preventing Central Line-Associated Bloodstream Infections (CLABSI): Results Of A Worldwide Survey. Antimicrobial Resistance & Infection Control, 2016, Vol.5:49 DOI 10.1186/S13756-016-0139-y
Yokoe D.S., Anderson D.J., Berenholtz S.M., et al. (2014). Introduction to “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates.” Infect Control Hosp Epidemiol 2014;35(5):455–459.
