Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals
Key Points
Key Points
- To reduce infectious complications, the subclavian vein is preferred for central venous catheter (CVC) insertion in the Intensive care unit (ICU).
- Use chlorhexidine-containing dressings in patients >2 months of age.
- Manually disinfect the catheter site. Antiseptic-containing caps are categorized as an additional approach.
- Remove non-essential catheters.
- This pocket guide highlights practical recommendations to assist acute care hospitals in implementing and prioritizing central line-associated bloodstream infection (CLABSI) prevention efforts.
- It is based on a synthesis of evidence, theoretical rationale, current practices, practical considerations, author consensus, and consideration of potential harm, where applicable.
- No guideline or expert guidance document can anticipate all clinical situations. This pocket guide is not meant to be a substitute for individual clinical judgment by qualified professionals.
Table 1. Risk Factors for CLABSI
a. ICU population: The risk of CLABSI in ICU patients is high.
Reasons for this include:
- The frequent insertion of multiple catheters
- The use of specific types of catheters that are almost exclusively inserted in ICU patients and are associated with substantial risk (e.g., pulmonary artery catheters with catheter introducers)
- The fact that catheters are frequently placed in emergency circumstances, repeatedly accessed each day, and often needed for extended periods of time.
Although the primary focus of attention over the last two decades has been the ICU setting, the majority of CLABSIs occur in hospital units outside of the ICU or in outpatients.
Infection prevention and control efforts should include other vulnerable populations, such as:
- Patients receiving hemodialysis through catheters
- Intraoperative patients
- Oncology patients
Other catheters besides standard CVCs also carry a risk of infection:
- Short-term peripheral catheters
- Peripherally-inserted central venous catheters (PICCs)
- Midline catheters
- Peripheral arterial catheters also carry a risk of infection
Independent risk factors for CLABSI:
- Prolonged hospitalization before catheterization
- Prolonged duration of catheterization
- Heavy microbial colonization at insertion site
- Heavy microbial colonization of the catheter hub
- Multi-lumen catheters
- Concurrent catheters
- Neutropenia
- Body mass index (BMI) >40
- Prematurity (i.e., early gestational age)
- Reduced nurse-to-patient ratio in ICU
- Parenteral nutrition
- Substandard catheter care (e.g., excessive manipulation of the catheter)
- Transfusion of blood products (in children)
Recommendations
...Recommend...
...Table 2. Recommenda...
...Essenti...
...dopted by all acute-care hospitals unless a cle...
...Before Insert...
...ovide easy access to an evidence-based lis...
2. Require education and competenc...
...ICU patients over 2 months of age...
...At I...
...n ICU and non-ICU settings, have a...
...Perform hand hygiene prior to catheter ins...
...clavian site is preferred to reduc...
...se an all-inclusive catheter cart or kit...
...se ultrasound guidance for catheter...
...Use maximum sterile barrier precautions...
...alcoholic chlorhexidine antiseptic for skin...
After...
...e appropriate nurse-to-patient ratio and...
...e chlorhexidine-containing dressings for CVC...
...tunneled CVCs in adults and children, ch...
...heter hubs, needleless connectors,...
...non-essential catheters. (M = Moder...
...placement of administration sets not used...
...urveillance for CLABSI in ICU and non-ICU setti...
...Additional A...
...be considered for use in locations and/...
...dult patients (H = High)2117033
...ric patients (M = Moderate)2117...
...ntimicrobial lock therapy for long-term CV...
...nant tissue plasminogen activating f...
...e infusion/vascular access teams fo...
...antimicrobial ointments for hemodialysis cat...
...an antiseptic-containing hub/connector cap/p...
...Approaches That...
...e antimicrobial prophylaxis for sho...
2. Do not routinely replace CVCs or arterial c...
...Unres...
...outine use of needleless connectors as a CLABSI pr...