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
...mmendations...
...Recommendations to Prevent CL...
...ntial Practices...
...adopted by all acute-care hospitals unless a clea...
...efore Inser...
...access to an evidence-based list of indicati...
...uire education and competency assessment of...
...tients over 2 months of age with a ch...
...Insertion
...on-ICU settings, have a process in place, such as...
.... Perform hand hygiene prior to cathete...
3. The subclavian site is preferred to re...
.... Use an all-inclusive catheter cart or kit. (M =...
...ltrasound guidance for catheter insertion. (H =...
...ximum sterile barrier precautions durin...
...Use an alcoholic chlorhexidine antiseptic f...
...r Insertion
...riate nurse-to-patient ratio and limit use...
...xidine-containing dressings for CVCs in pati...
...-tunneled CVCs in adults and children, c...
...isinfect catheter hubs, needleless connectors,...
...essential catheters. (M = Moderate...
...ine replacement of administration sets not used f...
...urveillance for CLABSI in ICU and non-IC...
...nal Approaches...
Can be considered for use in location...
...t patients (H = High)211...
...c patients (M = Moderate)21170...
...bial lock therapy for long-term CVCs. (...
...ant tissue plasminogen activating factor...
...ion/vascular access teams for reducing CLA...
...microbial ointments for hemodialysis ca...
...antiseptic-containing hub/connector...
...at Should Not Be Considered a Routine Part of CL...
...ntimicrobial prophylaxis for short-term...
...Do not routinely replace CVCs or arterial cathe...
...esolved Issues...
...tine use of needleless connectors as a CLABSI p...