CLABSI (Central Line-Associated Bloodstream Infection)

Definition

A Central Line-Associated Bloodstream Infection (CLABSI) is a primary bloodstream infection that develops in a patient with a central venous catheter and is not related to an infection at another site. CLABSIs are among the most serious healthcare-acquired infections, with mortality rates as high as 25%.

Common Pathogens

• Coagulase-negative Staphylococci
• Staphylococcus aureus (including MRSA)
• Enterococcus
• Gram-negative bacilli
• Candida species

Signs and Symptoms

• Fever, chills, hypotension
• Positive blood cultures (ideally drawn from central line and peripheral site)
• Erythema, induration, or purulence at catheter site
• Signs of sepsis

Prevention Bundle (IHI)

• Hand hygiene before catheter insertion or manipulation
• Maximal barrier precautions during insertion (cap, mask, sterile gown, sterile gloves, full-body drape)
• Chlorhexidine skin antisepsis with 30-second scrub, 2-minute dry
• Optimal catheter site selection (subclavian preferred; avoid femoral in adults)
• Daily assessment of line necessity with prompt removal
• Scrub the hub before each use (15-second alcohol scrub)

Nursing Considerations

Perform dressing changes using sterile technique per policy. Monitor insertion site each shift. Document line type, insertion date, and need. Advocate for early removal.

NCLEX Relevance

CLABSI prevention is a Joint Commission National Patient Safety Goal and highly tested infection control topic.