Central line infections, also called central line-associated bloodstream infections (CLASBI), can occur when a large tube is placed in a large vein in the neck, chest, groin or arms to give fluids, blood, or medications or to do certain medical tests quickly. While they allow exceptional access to internal systems, Central Venous Catheters (CVC) also can cause thousands of patient deaths a year and add billions of dollars in healthcare costs. However, these infections are entirely preventable.
In this health care scenario, patient safety is the foremost concern. So the most basic Cause Map would show that the Patient Safety Goal is impacted by preventable bloodstream infections, and that those infections come from pathogens introduced by a central line. The next step is to elaborate on how pathogens enter the bloodstream, and then determine what appropriate solutions might be.
Preventable bloodstream infections happen because pathogens access the bloodstream and also because the infections aren’t treated early on. This suggests that by treating infections early on, and vigilantly watching for signs of infection, more serious infections can be prevented.
Pathogens can access the bloodstream because a central line provides a direct conduit to the bloodstream and because pathogens are present. Again, while these are obvious statements, they allow the opportunity to develop potential solutions. First, the CDC recommends not using a CVC unless absolutely necessary. Additionally, CVCs shouldn’t be placed in the femoral artery in adults because it is associated with greater infection rates and secondary problems such as deep venous thrombosis.
Assuming a central line is necessary; more analysis leads to further solutions that might reduce the presence of pathogens. Pathogens generally come from two sources – the line was improperly put in or somehow the line became contaminated during use. Using antimicrobial materials is one potential way of minimizing contamination.
Looking closer at the uppermost branch , how the line was put in, leads to some insightful solutions. One simple solution recommended by the CDC is to use a checklist and follow their guidance. Checklists are a simple but highly effective way of reducing errors in repetitive processes. There are two major causes in this branch, dirty hands/gloves from the nurse or doctor putting the CVC in the patient and the patient having dirty skin at the site of the CVC. CDC guidance also recommends using maximal barriers such as masks and gloves and washing your hands. Cleaning the patient’s skin with a chlorhexidine-based solution is another important step that can reduce these infections.
With so many possible solutions, it is important to identify where changes need to occur in your own processes. This is fairly simplistic Cause Map and there are many other solutions suggested by the CDC and other government health agencies. For more information on steps to reduce CLASBIs, see the U.S. Department of Health and Human Services Guideline.