Question

Central-venous-catheter-related bloodstream infections (CRBSIs)

what is CRBSIs , causes, signs and symptoms, management

(pharmacological), dressing changes, impact on health care, prevention

Answer 1

CENTRAL -VENOUS-CATHETER-RELATED BLOODSTREAM INFECTIONS (CRBSIs):

• IT REFERS TO THE DEVELOPMENT OF BACTEREMIA IN WHICH THE SOURCE OF INFECTION IS FROM THE INTRAVENOUS CATHETERS.
• IT IS A HOSPITAL-ACQUIRED (NOSOCOMIAL )INFECTION WHICH IS A SERIOUS AND COSTLY COMPLICATION.
• IT HAS THE HIGHER RISK OF INCREASED MORBIDITY AND MORTALITY.

CAUSES OF CENTRAL- VENOUS -CATHETER -RELATED BLOOD STREAM INFECTIONS:

• METHOD INVOLVED IN THE THE INSERTION OF THE CATHETER.
• SITE OF CATHETER INSERTION.
• DURATION OF THE PROCEDURE TO INSERT THE CATHETER.
• ANY COMORBID CONDITION OR UNDERLYING DISEASES.
• ADMINISTRATION OF PARENTERAL NUTRITION THROUGH THE INTRAVASCULAR CATHETERS INCREASES THE CHANCE OF CRBSIs.
• LACK OF PERSONAL HYGIENE.
• PRESENCE OF MOISTURE AROUND THE INSERTION SITE.

SYMPTOMS:

• HIGH INCREASE IN TEMPERATURE WITH RIGORS.
• SUDDEN AND UNEXPECTED LOW BLOOD PRESSURE .
• MALAISE, VOMITING AND
• ALTERED MENTAL STATUS.

SIGNS:

• PRESENCE OF ERYTHEMA, SWELLING OR TENDERNESS AT THE INSERTION SITE.
• PRESENCE OF PURULENT DISCHARGE AROUND THE INSERTION SITE OF THE CATHETER.
• SEVERE SEPSIS
• METASTATIC INFECTIONS SUCH AS INFECTIVE ENDOCARDITIS, OSTEOMYELITIS, SEPTIC EMBOLI.

MANAGEMENT(PHARMACOLOGICAL):

• ANTIMICROBIAL THERAPY:SYSTEMIC ANTIMICROBIAL THERAPY WITH CATHETER SALVAGE IMPLEMENTATION IS EFFECTIVE TO TREAT THE INFECTION.
• ANTIBIOTIC LOCK THERAPY:IT REFERS TO FILLING OF THE CATHETER LUMEN WITH SUPRA-THERAPEUTIC CONCENTRATION OF ANTIBIOTICS AND LEAVE THEM TO INDWELL FOR HOURS OR DAYS DEPENDING ON THE SEVERITY OF THE INFECTION .
• BOTH ANTIMICROBIAL THERAPY AND ANTIBIOTIC THERAPY MAY BE USED IN COMBINATION CERTAIN CONDITIONS IF REQUIRED .

DRESSING CHANGES:

• CHLORHEXIDINE -GLUCONATE IMPREGNATED DRESSING WILL REDUCE THE INFECTION AT THE CATHETER SITE .
• FREQUENCY OF DRESSING CHANGE SHOULD BE MINIMAL TO AVOID DAMAGE TO THE SURROUNDING SKIN AND PAIN WHILE REMOVING THE DRESSING.

IMPACT ON HEALTHCARE:

• CRBSIs HAVE LED TO THE DEVELOPMENT OF MULTIMODAL INTERVENTION TECHNIQUES FOR THE PREVENTION AND THE TREATMENT OF THE DISEASE.
• INITIATION OF TRAINING PROGRAMMES FOR HEALTHCARE WORKERS ABOUT THE THE TECHNIQUE AND MAINTENANCE OF CATHETER INSERTION.
• COLLECTION OF FEEDBACK FROM THE ATTENDING STAFFS.
• IMPLEMENTATION OF EVIDENCE-BASED GROUP OF PRACTICES.

PREVENTION:

• ENSURE THAT THE DESIGNATED STAFFS ARE PROPERLY TRAINED AND EDUCATED ABOUT THE APPROPRIATE TECHNIQUE OF THE CATHETER INSERTION AND CARE OF THE PATIENT.
• APPROPRIATE SELECTION OF CATHETER SIZE AND THE LOCATION OF INSERTION.
• REGULAR EVALUATION OF THE INSERTION SITE FOR ANY SWELLING,TENDERNESS OR DISCHARGE.
• REMOVAL OF THE CATHETER AT THE APPROPRIATE TIME WHEN NO LONGER IS REQUIRED.
• PROPER MAINTENANCE OF HAND HYGIENE AND IMPLEMENTATION OF ASEPTIC MEASURES WHILE INSERTION OF THE CATHETER.