Management
Table 1. Recommendations
5. Risks vs. benefits of CHG bathing NICU patients:
• Routine CHG bathing is not recommended for all NICU infants.
• In NICUs with high CLABSI rates (see Recommendation 10), despite
implementation of other evidence-based strategies, CHG bathing may be used in the
NICU for infants with CVCs. The optimal frequency of CHG-bathing has not been
established and depends on chronological age and gestational age.
▶ CHG bathing in term infants (≥37 weeks) may be performed from birth.
▶ CHG bathing in preterm infants (<37 weeks' gestation) may be considered beginning
at 4 weeks of chronological age, recognizing the potential for skin irritation and
systemic absorption (the latter being of unknown clinical significance).
▶ CHG bathing in preterm infants (<37 weeks' gestation) and <4 weeks of age is not
recommended due to potential adverse local and systemic effects. In these infants, an
alternative approach of bathing with sterile water with or without mild soap may help
decrease skin bacterial counts on skin.
▶ When CHG bathing is utilized, NICUs should ensure careful surveillance for local
and systemic adverse effects, including allergic reactions.
6. Practical strategies for minimizing central line entry in NICU patients:
• NICUs should perform laboratory and diagnostic stewardship (i.e., consolidation of
necessary tests and elimination of those not clinically relevant).
• HCP should avoid using the CVC to obtain routine blood tests.
• Although not a universal recommendation, NICUs may consider the use of closed
blood sampling systems.
• The utility of obtaining blood cultures through an indwelling CVC remains an
unresolved issue.
7. Implementation of prophylactic antimicrobial lock therapy in NICU patients:
• Prophylactic antimicrobial lock therapy as a universal prevention measure is not
recommended.
• Antimicrobial locks may be considered as an additional intervention in NICU infants
with recurrent CLABSIs.
8. Administration of prophylactic antimicrobials to a NICU patient at the time of
peripherally inserted central catheter (PICC) removal to reduce the incidence of
CLABSI or culture-positive sepsis:
• Prophylactic antimicrobials are not recommended at the time of PICC removal.
9. Practical considerations for the implementation of a neonatal vascular access team (VAT):
• NICUs should consider use of a VAT. Such teams have demonstrated effectiveness in
reducing catheter-related complications and are cost-effective.
• VAT proceduralists should receive education and clinical training, and upon
completion, demonstrate knowledge and proficiency in PICC insertion, care, and
removal, and a commitment to the team-based approach.
• VAT proceduralists should successfully insert a pre-defined number of PICCs as
defined by the local facility's delineation of privileges.
• The team should monitor relevant quality measures (see Table 6).
(cont'd)
