CLABSI

CLABSI stands for central line-associated bloodstream infection. It is a bloodstream infection that occurs in a patient who has had a central venous catheter in place, typically within 48 hours before the onset of infection, and is not attributable to an infection at another site. CLABSI is a major category of healthcare-associated infection and is associated with increased morbidity, length of hospital stay, and healthcare costs, particularly in critically ill patients.

Pathogenesis involves intravascular devices providing a portal of entry for bacteria and fungi. Organisms can originate from the patient’s skin around the catheter or intraluminal colonization of the catheter itself, with disruption of skin barriers or prolonged catheterization increasing risk.

Diagnosis relies on clinical signs such as fever or sepsis and laboratory evidence of bloodstream infection, with blood cultures obtained from peripheral veins. The definition used for surveillance emphasizes that the patient has a central line and that the bloodstream infection is not secondary to an infection at another site.

Prevention focuses on a bundle of measures: strict hand hygiene, maximal sterile barrier precautions during catheter insertion, chlorhexidine skin antisepsis, selecting the appropriate site, prompt removal of unnecessary catheters, and meticulous catheter maintenance including dressing changes and hub/line access practices. Some centers use antiseptic- or antibiotic-impregnated catheters or lock solutions in select situations, guided by local policy.

Management includes prompt assessment, obtaining cultures, and empiric antimicrobial therapy guided by local guidelines, with catheter removal when feasible or when the infection is suspected to involve the catheter.