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

Publication Date: April 18, 2022
Last Updated: November 15, 2023

Recommendations

Essential Practices

Should be adopted by all acute-care hospitals unless a clear and compelling rationale for an alternative approach is present.

Before Insertion

1. Provide easy access to an evidence-based list of indications for CVC use to minimize unnecessary CVC placement. (L = Low)
2117033
2. Require education and competency assessment of healthcare personnel (HCP) involved in insertion, care, and maintenance of CVCs about CLABSI prevention. (M = Moderate)
2117033
3. Bathe ICU patients over 2 months of age with a chlorhexidine preparation on a daily basis. (H = High)
2117033

At Insertion

1. In ICU and non-ICU settings, have a process in place, such as a checklist, to ensure adherence to infection prevention practices at the time of CVC insertion. (M = Moderate)
2117033
2. Perform hand hygiene prior to catheter insertion or manipulation. (M = Moderate)
2117033
3. The subclavian site is preferred to reduce infectious complications when the catheter is placed in the ICU setting. (H = High)
2117033
4. Use an all-inclusive catheter cart or kit. (M = Moderate)
2117033
5. Use ultrasound guidance for catheter insertion. (H = High)
2117033
6. Use maximum sterile barrier precautions during CVC insertion. (M = Moderate)
2117033
7. Use an alcoholic chlorhexidine antiseptic for skin preparation. (H = High)
2117033

After Insertion

1. Ensure appropriate nurse-to-patient ratio and limit use of float nurses in ICUs. (H = High)
2117033
2. Use chlorhexidine-containing dressings for CVCs in patients over 2 months of age. (H = High)
2117033
3. For non-tunneled CVCs in adults and children, change transparent dressings and perform site care with a chlorhexidine-based antiseptic at least every 7 days or immediately if the dressing is soiled, loose, or damp. Change gauze dressings every 2 days or earlier if the dressing is soiled, loose, or damp. (M = Moderate)
2117033
4. Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter. (M = Moderate)
2117033
5. Remove non-essential catheters. (M = Moderate)
2117033
6. Routine replacement of administration sets not used for blood, blood products, or lipid formulations can be performed at intervals up to 7 days. (H = High)
2117033
7. Perform surveillance for CLABSI in ICU and non-ICU settings. (H = High)
2117033

Additional Approaches

Can be considered for use in locations and/or hospital patient populations when HAIs are not controlled after implementation of essential practices.
1. Use antiseptic- or antimicrobial-impregnated CVCs:
in adult patients (H = High)
2117033
in pediatric patients (M = Moderate)
2117033
2. Use antimicrobial lock therapy for long-term CVCs. (H = High)
2117033
3. Use recombinant tissue plasminogen activating factor (rt-PA) once weekly after hemodialysis in patients undergoing hemodialysis through a CVC. (H = High)
2117033
4. Utilize infusion/vascular access teams for reducing CLABSI rates. (L = Low)
2117033
5. Use antimicrobial ointments for hemodialysis catheter insertion sites. (H = High)
2117033
6. Use an antiseptic-containing hub/connector cap/port protector to cover connectors. (M = Moderate)
2117033

Approaches That Should Not Be Considered a Routine Part of CLABSI Prevention

1. Do not use antimicrobial prophylaxis for short-term or tunneled catheter insertion or while catheters are in situ. (H = High)
2117033
2. Do not routinely replace CVCs or arterial catheters. (H = High)
2117033

Unresolved Issues

  1. Routine use of needleless connectors as a CLABSI prevention strategy before an assessment of risks, benefits, and education regarding proper use.
  2. Surveillance of other types of catheters (e.g., peripheral arterial or venous catheters).
  3. Standard, nonantimicrobial transparent dressings and CLABSI risk.
  4. The impact of using chlorhexidine-based products on bacterial resistance to chlorhexidine.
  5. Sutureless securement.
  6. Impact of silver zeolite-impregnated umbilical catheters in preterm infants (applicable in countries where it is approved for use in children).
  7. Necessity of medical disinfection of a catheter hub, needleless connector, and injection port before accessing the catheter when antiseptic-containing caps are used.

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

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

Authoring Organizations

Infectious Diseases Society of America

Society for Healthcare Epidemiology of America

Publication Month/Year

April 18, 2022

Last Updated Month/Year

October 9, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

Previously published guidelines provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates the Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

Target Patient Population

Acute care patients

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Keywords

antimicrobial prophylaxis, hospital-acquired infection, central line-associated bloodstream infection (CLABSI), chlorhexidine, acute care, ICU, hemodialysis, CVC, PICC, nurse-to-patient ratio, antimicrobial lock therapy

Source Citation

Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology. 2022;43(5):553-569. doi:10.1017/ice.2022.87

Methodology

Number of Source Documents
266
Literature Search Start Date
December 31, 2011
Literature Search End Date
July 31, 2021