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Central Line-Associated Bloodstream Infection (CLABSI) is a severe healthcare-associated infection, especially among ICU and hospital patients. In this blog, we walk you through the fundamental elements of CLABSI — what it is, how it occurs, and what risk factors expose a patient to it.
What is CLABSI?
CLABSI is an abbreviation for Central Line-Associated Bloodstream Infection. It describes a bloodstream infection in a patient with a central venous catheter (CVC) during the previous 48 hours.
The points are:
- The patient now has a central line or had it removed in the past 48 hours before infection symptoms set in.
- No other source of infection can be identified.
- It frequently relies on clinical judgment to differentiate true infection from secondary bacteremia or contamination.
Surveillance definitions by organisations such as the CDC and NHSN are useful, but they don’t always validate the catheter as the immediate cause.
What Increases the CLABSI Risk Factors?
Several catheter-related and patient-related factors determine the occurrence of CLABSI. Here’s the breakdown:
1. Catheter Type
- Non-tunnelled central venous catheters (CVCs) are the most risky.
- Tunnelled CVCs have a slightly lower risk.
- PICC lines (Peripherally Inserted Central Catheters) have even lower risk.
- Peripheral lines carry minimal to no risk.
2. Site of Insertion
- Subclavian vein: Low risk
- Internal jugular vein: Moderate risk
- Femoral vein: Highest risk (although some studies consider IJV and femoral risks equal if aseptic precautions are taken)
3. Duration of Use
- Risk becomes significantly higher after 7–14 days of catheter usage.
4. Urgency of Insertion
- Emergency catheter insertions are more dangerous as a consequence of suboptimal aseptic technique.
5. Insertion Technique
- Inadequate full barrier precautions raise risk — gloves, gown, mask, and drapes should be utilised appropriately.
6. Skin Condition
- Skin inflammation or colonisation at the site of insertion increases the risk of infection.
Pathogenesis: The Way CLABSI Emerges
CLABSI can result from various pathways:
1. Extraluminal Route (Most Frequent)
- Bacteria travel from the skin surface down the catheter tract into the blood.
- Common with early infections (within days of catheter insertion).
2. Intraluminal Route
- Happens through hub contamination, particularly with long-term catheters.
- Bacteria are introduced through the lumen at the time of drug infusion.
3. Hematogenous Seeding
- Uncommon. When an infection at a distant site extends to the catheter.
4. Infusate Contamination
- Extremely uncommon but dangerous — contaminated IV solution or additives place pathogens directly into the bloodstream.
Final Thoughts
CLABSI is a serious but preventable condition, but only if there is strict compliance with infection control measures — from catheter choice and placement to maintenance and removal at the right time. Identification of the pathogenesis and risk factors is the beginning of effective prevention.
Whether you’re an ICU clinician or a medicine resident, getting these details right can literally be a matter of life and death.
Keep learning and stay safe — because every line inserted is a chance to save a life, but only if done the right way.
