Clinical Microbiology: Open Access

Prevention of Central-Line Infection in Nursing Practice

Peter Pronovost^* Department of Virology, Johns Hopkins University School of Medicine, Maryland, USA
^*Correspondence: Peter Pronovost, Department of Virology, Johns Hopkins University School of Medicine, Maryland, USA, Email:

Received: 25-Nov-2022, Manuscript No. CMO-22-19546; Editor assigned: 28-Nov-2022, Pre QC No. CMO-22-19546(PQ); Reviewed: 15-Dec-2022, QC No. CMO-22-19546; Revised: 22-Dec-2022, Manuscript No. CMO-22-19546(R); Published: 30-Dec-2022, DOI: 10.35248/2327-5073.22.11.320

Description

In order to administer medication or fluids, collect blood for diagnostic testing, or implant a catheter (tube) in a major vein in the neck, chest, or groyne, doctors frequently use central lines, also known as central venous catheters. Intravenous catheters, sometimes called IVs, are routinely used to provide medication or fluids into a vein close to the skin's surface (typically on the arm or hand), for brief periods of time. Contrary to IVs, central lines access a large vein close to the heart, can stay in place for weeks or months, and are considerably more likely to result in serious infection [1]. This makes central lines different from IVs. In intensive care units, central lines are frequently employed.

When bacteria or viruses enter the circulation through the central line, it can lead to a dangerous infection known as a Central Line-Associated Bloodstream Infection (CLABSI). When placing the line, medical professionals must adhere to a stringent protocol to guarantee that the line stays sterile and that a CLABSI does not occur [2]. Healthcare professionals must appropriately implant the central line and follow strict infection control procedures each time they examine the line or alter the dressing. Patients who develop a CLABSI may also have red skin and pain near the central line in addition to a fever. If this occurs, medical professionals can do tests to find out if an infection is present.

There are two types of central lines are (1) tunnelled catheters, which are inserted surgically into the internal jugular, subclavian, or femoral vein for long-term (weeks to months) uses like chemotherapy or haemodialysis, and (2) non-tunneled catheters, which are more frequently used. The majority of CLABSIs are caused by temporary central venous catheters placed percutaneous. Bacteria on the skin surface move over the external surface of the catheter from the skin exit site to the intravascular region within 7 to 10 days of its implantation. The cuff on most tunnelled catheters triggers a fibrotic reaction around the catheter, forming a barrier to bacterial migration [3]. Non-tunneled catheters are more susceptible to CLABSIs because they lack a tunnel (a subcutaneous tract). CLABSIs that persist for longer than ten days are typically caused by hub contamination (intraluminal), typically from contaminated hands of a healthcare provider, rarely from a host, and frequently as a result of a breakdown of conventional aseptic procedures to access the hub. Hematogenous seeding of bacteria from a tainted infusate or another source is one of the less frequent ways.

Chronic illnesses (hemodialysis, cancer, gastrointestinal problems, pulmonary hypertension), immune-suppressed conditions (organ transplant, diabetes mellitus), malnutrition, total parenteral nutrition, advanced age, loss of skin integrity (burns), and prolonged hospitalisation prior to line insertion are host factors that raise the risk of CLABSI [4]. The risk of CLABSI is highest for femoral central venous catheters, followed by internal jugular and subclavian catheters. Further factors that affect the risk of CLABSI include the kind of catheter, insertion circumstances (emergency versus elective, use of full barrier measures versus limited), catheter management, and operator skill.

Neutropenia, severe sickness, or previous colonisation with Pseudomonas is frequently related conditions. Femoral catheterization, TPN, chronic use of broad-spectrum antibiotics, hematologic malignancy, solid organ transplantation, and hematopoietic stem cell transplantation are risk factors for the development of candida. Extracellular polysaccharide, or "slime (biofilm)," is a substance produced by some bacteria such staphylococci, pseudomonas, and candida that promotes greater virulence, adhesion to catheter surfaces, and resistance to antimicrobial therapy [5]. The source and severity of central line infections affect the course of treatment. To determine the source of the infection, the medical staff will run tests. In most cases, this entails drawing blood from the central line and at least one sample from a vein using a needle. To determine if the central line or another place is the infection's source, samples from other areas of the body, such as the urine, may also be taken. To determine whether there are bacteria or fungi present, cultures are done on the samples.

Antibiotics or antifungal medications are often used once the infection's cause has been identified. To treat CLABSI, a central line removal may be required. Sometimes a new device is installed in lieu of the central line, sometimes at a different location. Alternately, the central line could be totally withdrawn until the infection has disappeared. It is crucial to provide antibiotics through the central line to treat line infection if it is kept in situ. Patients will be constantly watched both during and following treatment. Even if there are no symptoms of infection, it is crucial that patients continue to take their medications as directed.

References

1. Frasca D, Dahyot-Fizelier C, Mimoz O. Prevention of central venous catheter-related infection in the intensive care unit. Crit Care. 2010; 14(2):1-8.

   [Crossref] [Google Scholar] [PubMed]

2. Han Z, Liang SY, Marschall J. Current strategies for the prevention and management of central line-associated bloodstream infections. Infect Drug Resist. 2010;3:147.

   [Crossref] [Google Scholar] [PubMed]

3. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012; 40(8):2479-2485.

   [Crossref] [Google Scholar] [PubMed]

4. Kuhar D, Pollock D, Yokoe D, Howell M, Chopra V. Healthcare infection control practices advisory committee (HICPAC). 2018.

   [Google Scholar]

5. Pronovost P, Needham D, Berenholtz S, Sinopoli D. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006; 355(26):2725-2732.

   [Crossref] [Google Scholar] [PubMed]