Catheter Related Blood Stream Infection: A Growing Concern

 

Catheter Related Blood Stream Infection

An overview

Catheter-related bloodstream infections, also known as CRBSIs, are infections that occur when bacteria or other germs travel through an intravenous catheter or IV line directly into a patient's bloodstream, causing sepsis. CRBSIs are a serious type of hospital-acquired infection and can be life-threatening, especially if not diagnosed and treated promptly.

Causes and risk factors of Catheter Related Blood Stream Infection

The most common cause of Catheter Related Blood Stream Infection is the patient's own skin flora entering the bloodstream via the catheter. Bacteria easily colonize on the outer surface of the catheter and then make their way inside through any breaks in the integrity of the catheter. Some of the major risk factors that increase the chances of developing a CRBSI include:

- Prolonged use of catheters - Longer the duration a catheter remains inside, higher is the risk of infection. Catheters should be removed as soon as they are no longer needed.

- Improper insertion and care of catheters - Not following aseptic techniques during insertion and dressing changes can introduce skin flora or environmental organisms into the catheter site.

- Patient factors - Patients with weakened immune systems due to underlying conditions like cancer, diabetes or those on immunosuppressive drugs have reduced ability to fight infections.

- Device-related factors - Catheters with multiple lumens, cuffs or filters have been linked to higher infection risks compared to simpler short, single-lumen catheters.

Symptoms and diagnosis of Catheter Related Blood Stream Infection

The signs and symptoms of CRBSIs may not always be immediately apparent as patients can experience varying degrees of illness. Some of the common symptoms include fever, chills, increased heart rate, low blood pressure and swelling, redness or pain at the catheter insertion site. Blood cultures are done to confirm the presence of bacteria or other pathogens in the bloodstream that are not normally present. If CRBSI is diagnosed, the infected catheter needs to be removed promptly.

Treatment and management of Catheter Related Blood Stream Infection

Once diagnosed, CRBSIs require immediate antibiotic treatment targeted at the identified bacterial pathogen based on culture sensitivities. The infected catheter must be removed and the treatment course of intravenous antibiotics continued for 7-21 days depending on the severity of infection. It is important that the new catheter be placed in a different vein from the original site to prevent recurrence.

The infection site needs to be cleaned and monitored daily for healing. Supportive measures like fluids and medications to stabilize vital functions may also be required. While most cases resolve with appropriate treatment, delayed diagnosis or incorrect antibiotic usage can sometimes lead to complications like septic shock and organ damage in severe cases.

Preventing Catheter Related Blood Stream Infection through evidence-based practices

Nearly 80% of all CRBSIs are considered preventable with strict adherence to infection control guidelines and protocols. Some effective prevention strategies adopted globally include:

- Hand hygiene compliance by all healthcare workers before and after any catheter access

- Aseptic insertion and sterile dressing change practices using full barrier precautions

- Use of chlorhexidine for skin antisepsis prior to catheter insertion or access

- Regular review of line necessity and prompt removal of unnecessary catheters

- Surveillance cultures from catheter tips in high-risk units to detect potential outbreaks

- Care bundles or checklists to ensure all line maintenance steps are followed correctly

The risks of CRBSIs can also be reduced by using the minimum number of lumens required, replacing catheters every 3-5 days if still needed, and using antimicrobial or antiseptic impregnated catheters whenever possible. With diligent prevention efforts, we can curb this costly and potentially life-threatening hospital-acquired infection.

Rising Cases Of Catheter Related Blood Stream Infection Globally

Despite prevention guidelines, the global burden of CRBSIs remains unacceptably high. Data from the United States indicates CRBSIs affect an estimated 250,000 patients annually, leading to extensive use of antibiotics, lengthier hospital stays and increased medical costs. According to CDC estimates, these infections add over $296 million to the US healthcare bill each year. Even developed countries like the UK report up to 11,000 CRBSIs every year across National Health Service facilities.

In low and middle-income countries where resources are more limited and overburdened hospitals struggle to adhere to basic standards, the rates are projected to be much higher. A study assessing CRBSI incidence across 550 ICUs in 50 countries shockingly found the average was as high as 4.3 per 1000 catheter days. Countries like India, Egypt, Pakistan and others are estimated to have hundreds of thousands of additional CRBSI cases annually, exacerbating the growing burden of anti-microbial resistance globally. Better understanding of country and unit-specific risk factors is needed to prioritize preventive measures effectively.

The future of CRBSI prevention

While evidence-based guidelines have proved helpful in reducing infection rates gradually, new technological advancements also hold promise. Catheter materials infused with antibiotics, antiseptics or nitric oxide are currently being studied. Some early research shows these can quickly lower catheter colonization if further validated. Digital monitoring systems analyzing waveform characteristics are in trials to detect early catheter complications like CRBSIs by monitoring for subtle inflammatory signs, sometimes even before symptoms arise. Genomic and proteomic analysis of pathogens may offer new targets for improved diagnostic tests and personalized antibiotic therapies. As science progresses, multi-pronged innovative solutions tailored for each healthcare environment will be key to make CRBSIs a thing of the past.

In summary, catheter related blood stream infection are a major but preventable cause of illness, prolonged hospitalization and deaths worldwide each year. With the global rise in catheter usage and increasing antibiotic resistance, urgent multifaceted efforts are needed from policy makers, hospital administrators and frontline healthcare workers to implement best practices consistently. Surveillance data should continue guiding informed strategies. While elimination may not be realistic, CRBSI rates can definitely be reduced to under 1 per 1000 catheter days through diligence and employing the latest evidence-based scientific advances wherever possible. A collective determination is required to curb this persistent infection that negatively impacts both individual patients and public health systems.

 

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About Author
Alice Mutum, is a seasoned senior content editor at Coherent Market Insights, leveraging extensive expertise gained from her previous role as a content writer. With seven years in content development, Alice masterfully employs SEO best practices and cutting-edge digital marketing strategies to craft high-ranking, impactful content. As an editor, she meticulously ensures flawless grammar and punctuation, precise data accuracy, and perfect alignment with audience needs in every research report. Alice's dedication to excellence and her strategic approach to content make her an invaluable asset in the world of market insights.

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