In recent years, insertion of a central line has been a common procedure for both outpatient and inpatient settings. The central lines are used for renal replacement therapy, administration of medication, monitoring of hemodynamic state, and nutritional support, among others (Huybrechts et al., 2021). Likewise, patients in the intensive care unit (ICU) are in critical condition and require central lines for the aforementioned purposes. Therefore, central line insertion is a common procedure for ICU patients, and a correct insertion procedure must be adhered to.
Unfortunately, the central lines act as a passage of infective agents, including bacteria, viruses, and fungi. These infections are termed central-line-associated bloodstream infections (CLABSI). This is attributed to either wrong insertion procedures, poor maintenance of catheters, and failure to monitor the central lines. Once an infective agent accesses the body, it spreads through the bloodstream to cause severe systemic infection. CLABSI leads to an increased hospital stay that increases the cost of care, resulting in reduced patient outcomes.
Notably, up to 41000 new CLABSI infections are reported in the United States, with an estimated annual expenditure of 2.68 billion dollars (Huybrechts et al., 2021). Furthermore, despite the achievement in treating CLABSI with antibiotics, there has been a recent increase in antibiotic resistance. As a result, most healthcare institutions focus on preventive measures to reduce the rate of CLABSI and improve patient outcomes.
The proposed preventive measures include; aseptic insertion of a central catheter; proper maintenance by either dressing, cleaning, or bathing; appropriate hand hygiene, and removal of unnecessary catheters when not in use (Karagiannidou et al., 2019). Chlorhexidine has been used for bathing the central line leading to a reduced CLABSI rate. Most healthcare providers understand the importance of chlorohexidine; however, few adhere to the guidelines.
Therefore, this evidence-based proposal will discuss the effectiveness of chlorhexidine compared to normal saline in reducing the rates of CLABSI. The project aims at increasing knowledge among healthcare providers to adhere to daily bathing of central line with chlorohexidine. The PICOT question is: In patients admitted to ICU with a central line catheter (P), how does the use of chlorhexidine (I) compared with flushing the central line using normal saline (C) lead to the reduced central line-associated bloodstream infection (O) over six months (T)?
CLABSI is defined as any infection that develops within 48 hours of central line insertion or after catheter removal and cannot be related to other factors apart from the central line. It is the most common form of hospital-acquired infection (HAI) among patients admitted to the ICU. According to Haddadin et al. (2022), the annual incidence of CLABSI in the US is above 41000 cases, estimated as 0.8% per 1000 central line days. The same author states that the global incidence is estimated at 3.73% per 1000 central line days.
The increasing incidences lead to an increased hospital stay, reduced quality of life, increased mortality and morbidity, and increased cost of care. The estimated annual cost of care due to CLABSI has recently increased from 670 million dollars to 2.68 billion dollars (Karagiannidou et al., 2019). The increased expenditure strains the healthcare budget with an increased cost of care. However, untreated cases lead to mortality and morbidity. The global mortality rate is estimated at 12-25% (Payne et al., 2018). This rate is expected to rise if preventive measures are not adhered to.
Several microorganisms are known causes of CLABSI. They range from bacteria, viruses and fungi, with the commonest cause being bacteria. Staphylococci, including Staphylococci aureus and coagulase-negative staphylococci, are the leading causes of CLABSI. Enterococci, aerobic gram-negative bacilli, and yeast follow in that order (Haddadin et al., 2022). Notably, infections of the hemodialysis catheter are caused disproportionately by staphylococcus aureus. On the other hand, infections among patients with cancer are caused mainly by gram-negative bacilli. Yeast and gram-negative bacilli are common in femoral veins catheters, while candida infections are common in central lines for parenteral nutrition.
Various risk factors exist that increase the likelihood of a certain population to develop CLABSI, unlike others. These factors are related to either patient, healthcare providers, and catheter-related. CLABSI rate is increased among patients who are either immunocompromised, those with severe illness, granulocytopenia, or those with existing di
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