At IDWeek 2023 in Boston, Massachusetts, experts explored the issue of Central Line Associated Bloodstream Infections (CLABSIs), with an emphasis on the pediatric population. Leading this discussion was Jennifer Blumenthal, MD, known for her work in pediatric infectious diseases and critical care medicine at Boston Children’s Hospital and Harvard University School of Medicine. The focal point of her presentation was CLABSI, a laboratory-confirmed bloodstream infection not linked to an infection at another site, surfacing within two days of Central Venous Catheter (CVC) placement.
The national trend highlighted a significant increase in CLABSI cases during the COVID-19 pandemic, likely exacerbated by factors such as higher patient severity, staffing shortages, additional infection control demand, and disruptions in standard procedures coupled with supply chain issues. The risk factors encompass both clinical host-specific issues such as immunosuppression due to neutropenia or prematurity in infants, and situation-specific issues such as multiple catheter manipulations or low nursing-to-patient ratios.
However, an alarming revelation from a recent study signaled potential racial disparities in CLABSI development, with Black patients and patients whose primary language was not English observing a higher likelihood of developing CLABSI. These findings indicate that systemic racism and biases potentially seep into the fabric of hospital care, contributing to inequitable treatment for hospital-acquired infections.
To advocate for equality in CLABSI treatment, Dr. Blumenthal stressed on the need for quality improvement (QI) programs that consider race, ethnicity, and primary language indicators in their efforts to minimize disparities. Alongside, the revised SHEA/IDSA/APIC Practice Recommendations for preventing healthcare-associated infections in 2022 emphasized the importance of central line maintenance, and formal CVC insertion training to curb CLABSI development. They also recommended the use of chlorhexidine impregnated dressings and alcohol-based cap protectors. Continuing to focus on eradicating CLABSI, Dr. Blumenthal recommended a four-step measure: Engage, Educate, Execute, and Evaluate; each category executing its tasks equitably. This systemic application of these steps is paramount in successfully navigating against CLABSI, reducing infection, and promoting quality care in our healthcare industry.