Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals
Key Points
Key Points
Table 1. Risk Factors for CLABSI
- Intensive care unit (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.
- Non-ICU population:
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)
Management
...Management
...B...
...ide easy access to an evidence-based...
...equire education and competency assessment of...
...the ICU patients over 2 months of age...
...At Inse...
...and non-ICU settings, have a process in p...
...nd hygiene prior to catheter inserti...
...an site is preferred to reduce infectious comp...
...-inclusive catheter cart or kit. (M = Moder...
...rasound guidance for catheter insertion. (H = Hig...
...ile barrier precautions during CVC inser...
...oholic chlorhexidine antiseptic for skin prepar...
...After Ins...
Ensure appropriate nurse-to-patient ratio an...
...chlorhexidine-containing dressings for CVC...
...on-tunneled CVCs in adults and children, change tr...
Disinfect catheter hubs, needleless connect...
...non-essential catheters, (M = Mod...
...tine replacement of administration sets not us...
...erform surveillance for CLABSI in ICU...
...Addit...
...dult patients (H = High)2117033...
...n pediatric patients (M = Moderate...
...antimicrobial lock therapy for long...
...nt tissue plasminogen activating factor (rt-PA)...
...nfusion/vascular access teams for reducing C...
...l ointments for hemodialysis cathete...
...se an antiseptic-containing hub/connector cap/po...
...Approaches That Should N...
...t use antimicrobial prophylaxis for sho...
...ot routinely replace CVCs or arteria...
...Unres...
...f needleless connectors as a CLABSI...