Central Line-Associated
Bloodstream Infections
Key Points
Î The risk of central line-associated bloodstream infection (CLABSI) in
intensive care unit (ICU) patients is high.
Î However, the majority of CLABSIs occur in patients in hospital units
outside the ICU or in outpatients.
Î Infection prevention and control efforts should include other vulnerable
populations, such as patients receiving hemodialysis through catheters,
intraoperative patients, and oncology patients.
Î Besides central venous catheters (CVCs), peripheral arterial catheters
also carry a risk of infection.
Î Factors associated with increased risk:
• Prolonged hospitalization before catheterization
• Prolonged duration of catheterization
• Heavy microbial colonization at the insertion site
• Heavy microbial colonization of the catheter hub
• Internal jugular catheterization
• Femoral catheterization in adults
• Neutropenia
• Prematurity (ie, early gestational age)
• Reduced nurse-to-patient ratio in the ICU
• Total parenteral nutrition
• Substandard catheter care (eg, excessive manipulation of the catheter)
• Transfusion of blood products (in children)
Î Factors associated with reduced risk:
• Female sex
• Antibiotic administration
• Minocycline-rifampin-impregnated catheters
Basic Practices for Preventing and Monitoring CLABSI:
Recommended for All Acute Care Hospitals
Before insertion:
Î Provide easy access to an evidence-based list of indications for CVC use
to minimize unnecessary CVC placement (III).
Î Require education of HCPs involved in insertion, care, and maintenance
of CVCs about CLABSI prevention (II).
Î Bathe ICU patients over 2 months of age with a chlorhexidine
preparation on a daily basis (I).
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