Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals

Publication Date: April 19, 2022

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

Patients at risk for CLABSI in acute care facilities are those with a CVC in place:

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.
b. 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)

Recommendations

...ecommendat...

...ble 2. Recommendations to Prevent CL...

...ssential Prac...

...e adopted by all acute-care hospitals unles...

...efore Inser...

...ide easy access to an evidence-based list of in...

...quire education and competency assessment of he...

...Bathe ICU patients over 2 months of...

...Insertion...

...d non-ICU settings, have a process...

...rm hand hygiene prior to catheter insertion or man...

...an site is preferred to reduce infecti...

...e an all-inclusive catheter cart or ki...

.... Use ultrasound guidance for catheter in...

...maximum sterile barrier precautions dur...

...Use an alcoholic chlorhexidine antisept...

...r Insertion...

...re appropriate nurse-to-patient ratio a...

...hexidine-containing dressings for CV...

...on-tunneled CVCs in adults and childre...

...heter hubs, needleless connectors, and in...

...Remove non-essential catheters. (M = Moderate...

...replacement of administration sets not...

...veillance for CLABSI in ICU and non-I...

...dditional Appro...

...sidered for use in locations and/or hospital pati...

...patients (H = High)2117033...

...ediatric patients (M = Moderate)2117033...

...antimicrobial lock therapy for long-term CVCs. (...

...ombinant tissue plasminogen activating fac...

.... Utilize infusion/vascular access teams for...

...antimicrobial ointments for hemodial...

...an antiseptic-containing hub/connector cap/p...

...Should Not Be Considered a Routine Part of CLABS...

...o not use antimicrobial prophylaxis f...

...not routinely replace CVCs or arterial c...

...olved Issues...

...se of needleless connectors as a CL...