As many as 25 percent of bloodstream infections are fatal. The estimated cost for care of these patients in the United States is $2.3 billion annually.

The laboratory confirms a blood stream infection when the technician sees bacteria in the culture that is not related to an infection at another body site. The patient with infection in her blood has clinical signs or symptoms such as fever, hypotension, or oliguria (scant urine production). The physician must rapidly start treatment appropriate for sepsis.

Catheter-associated bloodstream infections can occur anywhere in the hospital. Both peripheral venous catheters and central venous catheters (CVC) can be the entryway for infection, but the central line catheter is most commonly associated with BSI. These are risk factors for getting a bloodstream infection:

• Underlying disease (i.e., cancer),
• Severity and type of illness (i.e., burns),
• Immunosuppression,
• Multiple traumas,
• The conditions under which the catheter is placed, i.e., emergency vs. elective placement,
• Techniques used during catheter placement, i.e., sterile technique vs. clean, and the type of catheter inserted.

The most common organisms linked to catheter BSIs are skin organisms that contaminate the catheter at the insertion site. These include coagulase-negative Staphylococcus and Staphylococcus aureus. Other infecting organisms are enterococcus, Escherichia coli, Enterobacter especially Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida(fungus) species. The intravenous site may become infected by the hands of the healthcare providers.

Minimizing the occurrence of catheter-related BSIs is a multi-step process. Meticulous care of the catheter and sterile technique during insertion are absolutely essential The CDC’s “Guidelines for the Prevention of Intravascular Catheter-Related Infections” include the following recommendations:

1. Educate healthcare workers about appropriate use and proper procedures for insertion and maintenance of intravascular catheters and proper procedures. Periodic evaluation of competence and knowledge regarding central line catheters use and care is suggested.
2. Ensure appropriate nurse to patient ratio to allow for adequate staff to be able to provide needed line care.
3. Monitor catheter sites for indications of blood stream infections or local infection.
4. Maintain hand hygiene procedures prior to contact with the central catheter using either antiseptic soap and water or waterless alcohol-based products.
5. Use only aseptic technique during insertion and care of the central line catheters. This includes donning sterile gloves during insertion of central line catheters.
6. Catheter site care includes proper skin antisepsis prior to insertion and during dressing changes. Use either sterile gauze or transparent dressings to cover the catheter site as needed. Dressings are to be changed at least weekly.
7. Use an insertion site with the least likely risk for complications.
8. Promptly discontinue catheters no longer indicated for patient care, and use clinical judgment in determining the need of catheter replacement.
Modified from “Infections in Hospitals and Nursing Homes” by Ginny Lee, MBA/HCM, MSN, RN, Luke Curtis, MD, MS, CIH, Jacqueline Vance RNC, CDONA/LTC and Lorraine M. Harkavy RN.

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