Catheter-associated bloodstream infection prevention: what is missing?

Abstract

The most frequent invasive procedure performed by nurses in acute care is venous access with 80% of patients in the USA, 60% of patients in the UK, and 33-67% of patients in Australia requiring intravenous access (Lavery, 2005; Hadaway, 2012; Wallis, 2014). Not only are vascular access devices the primary avenue for treatment administration, but many patients receive multiple intravenous medications and have more than one vascular access device (VAD). High usage of VADs, both central and peripheral, is not without risk of infection or other complications. Concerns regarding catheter-associated bloodstream infections are common with a general focus on central venous access devices (CVAD). Prevention for central line associated bloodstream infections (CLABSI) is concentrated on compliance with the five components of the central line bundle with variable success (Pronovost, 2006; Blot, 2014; Hsu, 2014). Preventive efforts and the application of new safety devices have resulted in actual cost reductions in addition to creating greater patient safety, reduced morbidity and mortality as well as an improved turnover of acute care bed space. Despite these worldwide efforts and general percentage reductions in infection over the past five years, more than 800 medium and large hospitals in the USA continue to have high CLABSI rates as do countless other hospitals throughout the world (Wise, 2013; Herzer, 2014).