CLABSIs: A Preventable Threat Is Still Costing Hospitals and Patients

Central venous catheters (CVCs) are used in several medical procedures, most of which are lifesaving. Yet they also pose a significant threat to both patients and hospitals due to their tendency to be a source of serious infection.

The CDC says infections that stem from CVCs, which are commonly known as central line-associated bloodstream infections (CLABSIs), cause thousands of deaths each year and result in billions of dollars in added costs to the US health care system. However, the CDC also says the costly consequences of CLABSIs are preventable.¹

The CDC’s position raises questions about why CLABSIs continue to be a problem if their sources and the steps needed to prevent them are well known. The answer to that question lies in the fact that the problem is not a knowledge gap but a systems gap. We understand the problem well, but most solutions still rely on perfect human execution, which is where the system breaks.

What Factors Make CLABSIs Difficult to Prevent and Deadly for Patients?

When placed, catheters become an unnatural and alien extension of a patient’s vascular system, poorly protected by the body’s blood-borne immune system and largely inaccessible to human mechanical intervention. The ideal aseptic solution for such an application is completely biocompatible with blood, doesn’t trigger the immune system, can be safely flushed into the body, has an osmotic profile that prevents blood from seeping into the catheter, prevents blood from coagulating, and preserves patency. That’s a very high bar, and it’s why source-level prevention remains so difficult to achieve consistently.

What we are left with is a medical tool that is effective for the same reasons that it is dangerous—it provides direct, long-term access to a vein near the heart. While the status of a peripheral IV is easy to assess, early-stage infections in CVCs are not always obvious because of their location and may go untreated until a serious infection is already shedding organisms into the bloodstream.

Once an infection or occlusion develops, it typically leads to complications with significant consequences for patients. The complexity and acuity of care increase at that point, leading to higher health risks and prolonged hospital stays for patients. Some studies have shown that CLABSIs increase hospital stay by 20 days.²

What Factors Make CLABSIs Costly for Hospitals

For hospitals, the impact of CLABSIs is greater and more subtle, with downstream effects across hospital units, hospital systems, and nationwide health care systems. Increased costs associated with prolonged stays are the most obvious impact.

Studies have shown that CLABSIs are the most expensive hospital-acquired infections, with each event costing approximately $48,000.³ Because CMS considers CLABSIs nonreimbursable hospital-acquired infections, the financial burden falls directly on hospitals.

Staff and patient satisfaction, as well as the costs associated with those metrics, are also meaningfully impacted by CLABSI-related issues. Patients who are being well cared for and recovering from their primary indication suddenly going septic is not only an existential threat for the patient, but also psychologically damaging for clinicians and other hospital staff.

What Factors Keep Hospitals From Reducing CLABSIs Events

Up to this point, the medical industry has largely placed the blame for central line complications on clinicians, and it has always been a mistake to do so. Proper sanitation, protocols, and training all matter, but when push comes to shove, the notion that common, life-threatening complications can only be prevented by a human through perfect adherence to protocol is flawed.

Clinicians are not perfect; they should not be expected to be, and patient safety should not depend on perfection to be effective. The right approach is one that reduces CLABSI risk even when clinical conditions are strained.

Hospitals aren’t always staffed appropriately. They may have sudden influxes of patients, patients may have emergent changes in health status, and clinicians may be interrupted during hand hygiene, among many other things. In a system known for its complexity and chaos, the goal should not be to create a solution that relies on perfect human performance. Rather, the goal should be to create a solution that retains its efficacy even when clinical conditions are subpar.

Naomi O’Grady, MD, FIDSA, the director of the procedures, vascular access, and Conscious sedation services, in the critical care medicine department, at the Warren Grant Magnuson Clinical Center at the National Institutes of Health Clinical Center, states it clearly: “The system we have in place for the prevention of CLABSI is clearly fragile and vulnerable to stress in the health care environment, particularly stress on the provider component of clinical care. We need to engineer resilient infection-prevention processes that can withstand changing environmental conditions and uncertain events. Although consistent reinforcement of preventive practices such as checklists is effective, it relies on limited staff who may have competing priorities when the health care system is strained.”⁴

The real challenge hospitals face isn’t whether clinicians understand infection prevention, but whether the systems around them are resilient enough to protect patients when the environment becomes strained. The future of CLABSI prevention will not be won by asking exhausted clinicians to perform perfectly inside imperfect systems. It will be won by designing processes, tools, and safeguards that make the safest action the easiest action, even when the hospital is under pressure.

References

1. Central line-associated bloodstream infection (CLABSI) basics. CDC. June 12, 2025. Accessed May 15, 2026. https://www.cdc.gov/clabsi/about/index.html
2. Mosquera JMA, Assis Reveiz JK, Barrera L, Liscano Y. Impact of central line-associated bloodstream infections on mortality and hospital stay in adult patients at a tertiary care institution in Cali, Colombia, 2015-2018. J Clin Med. 2024;13(18):5376. doi:10.3390/jcm13185376.
3. Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Agency for Healthcare Research and Quality. November 2017. Accessed May 15, 2026. https://www.ahrq.gov/hai/pfp/haccost2017-results.html.
4. O'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. N Engl J Med. 2023 Sep 21;389(12):1121-1131. doi: 10.1056/NEJMra2213296. PMID: 37733310.