Device-associated and healthcare-associated infection — formative SAQs

1. Surveillance syndrome and criteria

She may have a central-line-associated bloodstream infection (CLABSI): a laboratory-confirmed bloodstream infection in a patient with a central line in place for more than two calendar days, where the infection is not attributed to another site. The healthcare-associated time convention is onset more than 48 hours after admission, and she is well beyond both thresholds. I would count her against the unit's line-days denominator, but I would treat her on clinical grounds immediately rather than wait for surveillance adjudication. ^{[3] [12]}

2. Investigations, empiric therapy and the line decision

I would draw paired blood cultures from a peripheral site and from the line before antibiotics, and send a full blood count, C-reactive protein, electrolytes, renal and liver function, and a lactate. Because she is well perfused and not septic, I would start empiric antistaphylococcal cover for coagulase-negative staphylococci and Staphylococcus aureus, broadened per local guidance. Because the site is clean and she is clinically stable, immediate line removal is not mandated on the first positive culture, but I would set a clear threshold: remove the line if she develops sepsis, a tunnel or pocket infection, persisting or relapsing bacteraemia, or a resistant or high-risk organism. ^{[3] [12]}

3. Prevention bundle and the key risk factor

The bundle that should have been in place is multimodal: hand hygiene at the five moments, maximal sterile barriers at insertion, chlorhexidine skin preparation, optimal site selection, scrub-the-hub before every access, intact dressing care, and daily documented review of line necessity. The single greatest modifiable risk factor is the device itself, so the most reliable prevention is removing the line as soon as it is no longer essential. ^{[3] [12]}

4. Staphylococcus aureus changes the line decision

Staphylococcus aureus bacteraemia from a line is a high-risk organism with a strong tendency to seed distant foci, so the line should be removed, the child imaged for endocarditis and metastatic infection with echocardiography and targeted imaging, and therapy extended and guided by infectious diseases. This is one of the organisms for which line salvage is not appropriate. ^{[3] [12]}