Minimize Risk of CLABSI


In 2011, the Centers for Disease Control and Prevention (CDC) published evidence-based guidelines regarding the prevention of catheter-related bloodstream infections (CRBSIs).[1] The guidelines highlighted the fact that terminology associated with different types of bloodstream infections can be confusing because CRBSIs and central line–associated bloodstream infections (CLABSIs) have often been used interchangeably; however, their definitions are different.[1] A CRBSI is a clinical definition requiring confirmation by laboratory testing, whereas the definition associated with CLABSIs is most often used for

The National Healthcare Safety Network (NHSN) defines an incidence of CLABSI as “a primary BSI in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream related to an infection at another site.”[1]

Public Health Burden

The public health burden associated with hospital-acquired infections is substantial and includes increased morbidity and mortality, increased length of hospital stay, and increased costs. It is well known that CRBSIs are associated with increased morbidity
and mortality. Raad et al published an attributable mortality rate of 12% to 25% in the critical care patient population that experiences catheter-related bacteremia,[2]
and the CDC has published estimates that >92,000 CLABSIs occur in the US each
year.[3] Another study reported that nearly 80,000 CLABSIs occur in the US annually, with approximately 25,000 CLABSI-related intensive care unit (ICU) deaths.[4] The excess costs associated with each incidence of CLABSI ranges up to $29,156.3 Additional
estimates place the total economic burden of CLABSIs in the US at approximately $2 billion.[4]

Mastisol® Liquid Adhesive

Mastisol® Liquid Adhesive is a liquid medical adhesive used to secure dressings, tapes, and certain medical devices to ensure secure placement over an extended period of time. Mastisol® Liquid Adhesive is non-water soluble and comprises the following ingredients:

• Gum mastic
• Styrax
• Alcohol (SDA-23)
• Methyl salicylate

Mastisol 2/3mL Sterile Vials

Evidence-based guidelines have been published for the prevention of CRBSIs, and in 2011, recommendations published by the CDC led to a paradigm shift in the approach to catheter management.[1] This paradigm shift resulted from Category 1B CDC recommendations that stated, “Do not routinely replace central venous catheters (CVCs), peripherally inserted central catheters (PICCs), hemodialysis catheters, or pulmonary artery catheters to prevent catheter-related infections…and…Replace dressings used on short-term CVC sites at least every 7 days for transparent dressings, except in those pediatric patients in which the risk for dislodging the catheter may outweigh the benefit of changing the dressing.”[1] Another Category 1B recommendation from the same document states, “Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled.”[1] The paradigm shift was a clinical transition for standard of care, which shifted from routine and scheduled replacement of catheters and dressings to replacement only when clinically indicated up to every 7 days.[1]

Mastisol® Liquid Adhesive may help caregivers adhere to these best practice recommendations by preventing the loosening of dressings for up to 7 days, with enhanced securement and a non-water soluble composition, which in turn may prevent catheter insertion-site exposure and catheter dislodgement. In addition, recent laboratory testing has confirmed that Mastisol® Liquid Adhesive is compatible with chlorhexidine gluconate (CHG).[7] This compatibility is important from an adherence perspective because CHG skin preparation and CHG-impregnated dressings are recommended to reduce the risk of CRBSI,[1] and the documented compatibility of Mastisol® Liquid Adhesive with CHG ensures that application of Mastisol® Liquid Adhesive to enhance adhesion of CHG-impregnated dressings will not impact the effectiveness of the antimicrobial agent.[7]

Decreased Risk

The prevalence of dressing disruptions in the ICU population has not been studied in depth;8 however, prevalence estimates range from 15% in the non-ICU population9 to 40% in a hematologic population, [10] and other prevalence reports have indicated
that dressing nonadherence occurs in 11% to 57% of

The importance of dressing disruptions was highlighted in a multicenter randomized study conducted by Timsit et al.[8] A total of 1,419 patients were analyzed, and of 11,036 dressing changes, 67% (n = 7347) were changed before the planned date because of dressing disruption or soiling.8 This study conducted well-designed, multivariate logistic regression analyses and found that dressing disruption was related to the risk of CRBSI and colonization as follows [8]:

• The number of dressing disruptions was significantly associated with colonization of the skin around the catheter on removal (P < 0.0001).
• There was a 3-fold increased risk of major catheter-related infection and CRBSI after the second dressing disruption.
• There was a 12-fold increase in risk of major catheter-related infection and catheter colonization after the final dressing disruption.

Extensive research has been conducted on the effectiveness of Mastisol® Liquid Adhesive compared to tincture of benzoin, and Mastisol® Liquid Adhesive has been shown to result in fewer incidents of allergic dermatitis [13,14] and be superior in ensuring adherence of different types of tapes and dressings.[14-16] As a result, the risk of skin or catheter colonization or CRBSI related to dressing disruption may be reduced with the use of Mastisol® Liquid Adhesive.

Interested in seeing if Mastisol® Liquid Adhesive is a good fit for your facility?

1. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011 May; 39(4 Suppl 1): S1-34. doi: 10.1016/j.ajic.2011.01.033.
2. Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007 Oct; 7(10): 645-57. PMID: 17897607.
3. Scott RD Jr. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Centers for Disease Control and Prevention. March 2009. Available at: Accessed February 12, 2015.
4. Herzer KR, Niessen L, Constenla DO, Ward WJ Jr, Pronovost PJ. Cost-effectiveness of a quality improvement programme to reduce central line- associated bloodstream infections in intensive care units in the USA. BMJ Open. 2014 Sep 25; 4(9): e006065. doi: 10.1136/bmjopen-2014-006065.
5. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004 Jan; 30(1): 62-7. PMID: 14647886.
6. Bloc S, Garnier T, Mercadal L, Roy M, Dhonneur G. [Evaluation of synthetic glue for the fixation of continuous peripheral nerve catheters.] Ann Fr Anesth Reanim. 2008 Jan; 27(1): 103-5. doi: 10.1016/j.annfar.2007.10.038. (Article in French).
7. Data on file: CHG compatibility testing.
8. Timsit JF, Bouadma L, Ruckly S, Schwebel C, Garrouste-Orgeas M, Bronchard R, Calvino-Gunther S, Laupland K, Adrie C, Thuong M, Herault MC, Pease S, Arrault X, Lucet JC. Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med. 2012 Jun; 40(6): 1707-14. doi: 10.1097/CCM.0b013e31824e0d46.
9. Rasero L, Degl’Innocenti M, Mocali M, Alberani F, Boschi S, Giraudi A, Arnaud MT, Zucchinali R, Paris MG, Dallara R, Thaler S, Perobelli G, Parfazi S, De Lazzer T, Peron G. [Comparison of two different protocols on change of medication in central venous catheterization in patients with bone marrow transplantation: results of a randomized multicenter study.] Assist Inferm Ric. 2000 Apr-Jun; 19(2): 112–9. PMID: 11107366.
(Article in Italian).
10. Vokurka S, Bystricka E, Visokaiova M, Scudlova J. Once- versus twice-weekly changing of central venous catheter occlusive dressing in intensive chemotherapy patients: results of a randomized multicenter study. Med Sci Monit. 2009 Mar; 15(3): CR107–10. PMID: 19247240.
11. Maki DG, Stolz SS, Wheeler S, Mermel LA. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med. 1994 Nov; 22(11): 1729-37. PMID: 7956275.
12. Trick WE, Vernon MO, Welbel SF, Wisniewski MF, Jernigan JA, Weinstein RA. Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol. 2004 Mar; 25(3): 266-8. PMID: 15061422.
13. James WD, White SW, Yanklowitz B. Allergic contact dermatitis to compound tincture of benzoin. J Am Acad Dermatol. 1984 Nov; 11(5 Pt 1):
847- 50. PMID: 6239881.
14. Lesesne CB. The postoperative use of wound adhesives. Gum mastic versus benzoin, USP. J Dermatol Surg Oncol. 1992 Nov; 18(11): 990. PMID: 1430556.
15. Mikhail GR, Selak L, Salo S. Reinforcement of surgical adhesive strips. J Dermatol Surg Oncol. 1986 Sep; 12(9): 904-5, 908. PMID: 3528256.
16. Moy RL, Quan MB. An evaluation of wound closure tapes. J Dermatol Surg Oncol. 1990 Aug; 16(8): 721-3. PMID: 2394875.
17. Pullen D. Quality Improvement Initiative to Improve Dressing Adherence Reveals Improved Dressing Adherence Observations on a Before-After Analysis. Poster presented at: AVA Annual Scientific Meeting, September 7-10, 2014.
18. Deneau J, Craig A. Nursing Survey Reveals Novel Strategy in Assisting Adherence to Best Practices of CVC Dressing Management. Poster presented at: Institute for Healthcare Improvement National Forum, December 8-11, 2013.
19. Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA. Prevalence and source of pain in pediatric inpatients. Pain. 1996 Nov; 68(1): 25-31. PMID: 9251995.
20. Broome ME, Bates TA, Lillis PP, McGahee TW. Children’s medical fears, coping behaviors, and pain perceptions during a lumbar puncture. Oncol Nurs Forum. 1990 May-Jun; 17(3): 361-7. PMID: 2342970.
21. Nir Y, Paz A, Sabo E, Potasman I. Fear of injections in young adults: prevalence and associations. Am J Trop Med Hyg. 2003 Mar; 68(3): 341-4. PMID: 12685642.
22. Patel N, Smith CE, Pinchak AC, Hancock DE. The influence of tape type and of skin preparation on the force required to dislodge angiocatheters. Can J Anaesth. 1994 Aug; 41(8): 738-41. PMID: 7923524.
23. Centers for Medicare and Medicaid Services. Hospital Value-Based Purchasing. Available at: Accessed February 12, 2015.