CLABSI Prevention for Home Health Nurses

• Patients who have central venous catheters (central lines) are at risk of developing associated bloodstream infections.
• Simple steps Home Nurses can take during home care visits to prevent patients with central lines from developing CLABSI’s.
• How to detect CLABSIs early and advocate for the patient.

As a home health nurse, the nurse is responsible for the home care management of their patients.  There are simple measures that can be implemented in the home to prevent hospitalizations and deaths from CLABSIs.  In this article, we will explore ways home health nurses can prevent CLABSIs from developing and progressing in patients who are living at home with central lines.

What is a Central Line?

Central lines are intravenous catheters that are inserted either peripherally into a large vein (i.e., the arm or groin) or directly into a large vein in the chest.  Central line catheters are longer than the standard peripheral intravenous (IV) catheters because they extend to the level of the heart.

Central lines are used to administer medications and nutrition.  Central lines can also be used to draw blood and are inserted when patients need long-term infusions.  While the standard IV line is great for short-term use, central lines can be used for months.

Central Line-Associated Bloodstream Infection (CLABSI)

Patients who have central lines are at risk of developing an infection.  A CLABSI is a blood infection that originates from the central line itself.  Bacteria may enter the line through poor line maintenance (e.g., poor hand hygiene when handling the line or inadequate line dressing care).

These infections are serious and if left untreated can be fatal.  According to AHRQ, CLABSIs result in 10,426 to 25,145 preventable deaths each year.

CLABSIs require removal of the infected central line and antibiotic treatment and the patient may need a hospital stay.  AHRQ reported that CLABSIs cost the healthcare system $1.7 to $21.4 billion each year.  One of the goals of a home health nurse is to prevent patients from going to the hospital for illnesses that could have been prevented at home.

Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)

The best way to prevent CLABSIs in the home health setting is effective central line maintenance.

The following are three ways to decrease the risk of patients developing CLABSIs while they are at home:

Keep the central line dressing clean and dry

Bacteria at the site can lead to an infection within the central line system. A loose dressing, due to moisture or being soiled, can cause bacteria to enter.  Central lines should be dressed in a clean secure fashion in order to prevent bacteria from entering the insertion site.

Educate the patient on the importance of keeping the site clean and dry in between dressing changes. Precautions include protecting the site with a non-permeable covering when showering and avoiding full submersion of the site in water (i.e., pools and baths).

Use an aseptic technique when performing a central line dressing change

During central line dressing changes, there is a risk that bacteria may enter the line insertion site due to exposure to the environment.  The CDC recommends the use of sterile supplies when dressing the central line to prevent CLABSIs.

The aseptic technique is a method used during surgeries, wound care treatments, and certain nursing skills (e.g., urinary catheterization) to reduce the risk of bacterial transfer from a contaminated source to the patient’s body.  The aseptic technique involves handwashing and using clean or sterile supplies to prevent infection.

A central line dressing kit will contain the sterile supplies that are needed.

Always access the central line using an aseptic technique

Accessing a central line involves attaching a syringe or IV tubing to the port (entryway or hub) and infusing (or injecting) a medication or nutrient through the line.

Since the port is a barrier between the environment and the internal central line system, there is a risk of infection if the port is not cleansed appropriately prior to use.  The Joint Commission recommends scrubbing the access port with a fresh alcohol swab for at least 10-15 seconds prior to use (unless the manufacturer’s instructions direct otherwise).  If there is more than one port, use a separate swab for each one.

Early Detection of Central Line-Associated Bloodstream Infections (CLABSIs)

While there are things one can do to prevent CLABSIs in patients who have central lines, the nurse is not consistently with the patient around the clock; therefore, central line maintenance requires a team effort between the nurse, patient, and physician.

Following are some ways to detect a CLABSI before it worsens:

•  Monitor for signs of infection at the site – early detection of CLABSIs can be as simple as performing a central line site assessment if one is aware of the signs/symptoms to note.  Signs of infection include swelling, pain, yellow or green drainage, red streaking, and overall redness at the site.
• If the nurse notices any of these signs during the visit with the patient, notify the physician right away.  Daily assessment of the site is ideal; however, if the nurse does not see the patient every day, teach the patient what to look for and when to report to the physician.
• Perform temperature checks during each home visit – fever, especially if accompanied by the signs listed above may indicate a central line infection.  At each home visit, make a habit of checking the patient’s temperature.  Most importantly, educate your patient on the importance of notifying the physician right away if they develop a fever.  Early recognition and treatment of a CLABSI is the best way to prevent its progression.

The Bottom Line

As a home health nurse, you must serve as the patients’ primary advocate.  When performing home visits, ask the patients if they have noticed any changes to their central line site or if they have experienced any fevers.  Perform a temperature check, assess the central line site, and provide patient education as needed.  Inform the physician right away if an infection is suspected.

CLABSIs are preventable and by following the simple steps listed, one can prevent and detect early central line infections which can keep patients out of the hospital and safe in the comfort of their own homes.

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