In 2009, the federal government implemented Phase 1 of the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (formerly the HHS Action Plan to Prevent Health Care-Associated Infections)—an ambitious undertaking to significantly reduce the rates of HAIs across the United States.1 The Plan includes 4 Phases:
- Phase 1: Acute Care Hospitals
- Phase 2: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination among Health Care Personnel
- Phase 3: Long-Term Care Facilities
- Phase 4: Antibiotic Stewardship
Central line–associated bloodstream infections (CLABSIs) are one of the key HAI targets for the plan, and for good reason.1 CLABSIs affect approximately 41,000 people each year, resulting in significant morbidity and mortality, with an average cost of $70,696 (range $40,412-$100,980).2-4 The first CLABSI target—a 50% reduction from baseline (2010-2011) by 2013—was achieved.5 New targets were subsequently published, aiming for a further 50% reduction from baseline (2015) by year 2020.6
Snapshot on Progress
According to the National Healthcare Safety Network (NHSN), there was a 10% reduction in CLABSIs between 2015 and 2016.6 The most recent HAI Progress Report from the CDC additionally states that between 2016 and 2017, there was a 9% reduction in CLABSIs, with the greatest decrease occurring in non–intensive care unit (ICU) patient wards.7
Analysis of CLABSI data during this period, according to the Centers for Disease Control and Prevention (CDC), revealed that among adult ICU patients, there were greater reductions in CLABSI cases caused by Staphylococcus and Enterococcus spp than there were in gram negative and fungal pathogens.5 Additionally, much of the gains achieved in CLABSI reductions were attributed to improved central line insertion practices.5
Getting to the Finish Line
In its Data Summary of HAIs in the US: Assessing Progress 2006-2016 report, the CDC applauds the progress that has been made, but emphasizes that more work must be done to achieve the 2020 goals.5 In particular, they emphasize the “need to expand prevention through improved maintenance of central lines and other strategies.”5
Among the key components of central line maintenance are:8-9
- Hand hygiene
- Aseptic technique
- Disinfection of access port prior to use
- Appropriate dressing care
- Daily patient bathing
The Bathing Controversy
Regular cleaning of a patient’s skin to eliminate pathogens is an intuitive CLABSI prevention measure. Many CLABSIs occur when bacteria on the skin migrate through the insertion site along the catheter’s external surface and into the bloodstream.10 Current guidelines from the Society for Healthcare Epidemiology of America recommend daily patient bathing with chlorhexidine gluconate to reduce CLABSI risk.8
Yet in response to this recommendation, The Joint Commission cautions that: “Concern has been raised, however, regarding the potential for chlorhexidine resistance and whether widespread use of chlorhexidine gluconate bathing may create problems in the future.”9
In fact, reports of increasing resistance/reduced susceptibility to CHG among clinical isolates, particularly in high-use settings, are on the rise.11-17 A recent study from Johns Hopkins University found a 69% prevalence of reduced susceptibility among organisms causing CLABSIs between January 2012 and September 2013.14 Furthermore, CHG resistance among CLABSI-causing organisms was significantly higher in units where daily CHG bathing was performed compared to units without CHG bathing (86% vs. 64%, p=0.028).14
Looking to Alternatives: A Novel Topical Hygiene Solution
Theraworx Protect is a multi-ingredient skin formulation designed to reduce macro and micro debris from skin while simultaneously supporting the skin’s acid mantle and the natural antimicrobial functions of the skin’s outermost layer, the stratum corneum.18-19 As a non-antiseptic, non-drug product, Theraworx Protect can help you achieve your patient bathing goals without the risk of antiseptic resistance. Contact us for more information.
Did you know that biofilms are the cause of many device-related infections, including CLABSIs? Find out more about biofilms and their role in hospital-acquired infections.
- Office of Disease Prevention and Health Promotion. National action plan to prevent health care-associated infections: road map to elimination. Available from: https://health.gov/hcq/prevent-hai-action-plan.asp. Accessed 26 September 2019.
- Agency for Healthcare Research and Quality. Eliminating CLABSI, a national patient safety imperative: final report companion guide. Available from: https://www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicomp4c.html. Accessed 27 September 2019.
- Agency for Healthcare Research and Quality. Central line-associated bloodstream infections. Available from: https://www.ahrq.gov/topics/central-line-associated-bloodstream-infections-clabsi.html. Accessed 27 September 2019.
- National Center for Emerging and Zoonotic Infectious Diseases. NHSN central line-associated bloodstream infection surveillance in 2014. Available from: https://www.cdc.gov/nhsn/PDFs/training/training-CLABSI-2014-with-answers-BW.pdf. Accessed 27 September 2019.
- Centers for Disease Control and Prevention. Data summary of HAIs in the US: assessing progress 2006-2016. Available from: https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhai%2Fsurveillance%2Fdata-reports%2Fdata-summary-assessing-progress.html. Accessed 27 September 2019.
- Office of Disease Prevention and Health Promotion. Health care-associated infections: national targets and metrics. Available from: https://health.gov/hcq/prevent-hai-measures.asp. Accessed 27 September 2019.
- Centers for Disease Control and Prevention. Current HAI progress report: 2017 nation and state healthcare-associated infections progress report. Available from: https://www.cdc.gov/hai/data/portal/progress-report.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhai%2Fsurveillance%2Fprogress-report%2Findex.html#Data_tables. Accessed 27 September 2019.
- Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35(7): 753-771.
- The Joint Commission. CLABSI Toolkit-Chapter 3. Available from: https://www.jointcommission.org/topics/clabsi_toolkit__chapter_3.aspx. Accessed 27 September 2019.
- Haddadin Y, Regunath H. Central line associated blood stream infections (CLABSI). StatPearls 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430891/. Accessed 27 September 2019.
- Wang JT, Sheng WH, Wang JL, et al. Longitudinal analysis of chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan, J Antimicrob Chemother 2008; 62(3): 514-17.
- Batra R, Cooper BS, Whitely C, et al. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010; 50(2): 210-7.
- Zhang M, O’Donoghue MM, Hiramatsu K, et al. Prevalence of antiseptic-resistance genes in Staphylococcus aureus and coagulase-negative staphylococci colonizing nurses and the general population in Hong Kong. J Hosp Infect 2011; 78(2): 113-7.
- Suwantarat N, Carroll KC, Tekle T, et al. High prevalence of reduced chlorhexidine susceptibility in organisms causing central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2014; 35(9): 1183-186.
- Choudhury MA, Sidjabat HE, Rathnayake IU, et al. Culture-independent detection of chlorhexidine resistance genes qacA/B and smr in bacterial DNA recovered from body sites treated with chlorhexidine-containing dressings. J Med Microbiol 2017; 66: 447-453.
- Addetia A, Greninger AL, Adler A, et al. A novel, widespread qacA allele results in reduced chlorhexidine susceptibility in staphylococcus epidermis. Antimicrob Agents Chemother 2019; 63(6): e02607-18.
- Kampf G. Acquired resistance to chlorhexidine—is it time to establish an “antiseptic stewardship” initiative? J Hosp Infect 2016; 94:213-27.
- Paulson DS, Topp R, Boykin RE, Schultz G, Yang Q. Efficacy and safety of a novel skin cleansing formulation versus chlorhexidine gluconate. Am J Infect Control 2018; 46(11): 1262-1265.
- Wiemken TL, Kelley RR, Carrico RM, Binford LE, Guinn BE, Mattingly WA, et al. Efficacy of a novel skin antiseptic against carbapenem-resistant Enterobacteriaceae. Am J Infect Control 2015; 43(4): 380-382.