CLABSI Toolkit - 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.¹ 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 way^7,8:

  • CLABSI is the term used by the US Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN)⁹ (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"