Prevention
Prevention of Central Line-Associated Bloodstream Infection (CLABSI)
Basic practices for prevention and monitoring of CLABSI: (recommended for all acute care hospitals)
ÎBefore insertion
> Educate healthcare personnel involved in the insertion, care, and maintenance of central venous catheters about CLABSI prevention (A-II).
ÎAt insertion
> Use a catheter checklist to ensure adherence to infection prevention practices at the time of central venous catheter insertion (B-II).
> Perform hand hygiene before catheter insertion or manipulation (B-II). > Avoid using the femoral vein for central venous access in adult patients (A-I). > Use an all-inclusive catheter cart or kit (B-II). > Use maximum sterile barrier precautions during central venous catheter insertion (A-I). > Use a chlorhexidine-based antiseptic for skin preparation in patients older than 2 months of age (A-I).
ÎAfter insertion
> Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter (B-II).
> Remove nonessential catheters (A-II). > For non-tunneled central venous catheters in adults and adolescents, change transparent dressings and perform site care with a chlorhexidine-based antiseptic every 5-7 days or more frequently if the dressing is soiled, loose, or damp; change gauze dressings every 2 days or more frequently if the dressing is soiled, loose, or damp (A-I).
> Replace administration sets not used for blood, blood products, or lipids at intervals not longer than 96 hours (A-II).
> Perform surveillance for CLABSI (B-II). > Use antimicrobial ointments for hemodialysis catheter insertion sites (A-I).
Special approaches for the prevention of CLABSI:
(These special approaches are recommended for use in locations and/or populations within the hospital for which outcome data and/or risk assessment suggest lack of effective control despite implementation of basic practices.)
ÎPerform a CLABSI risk assessment.
ÎBathe intensive care unit (ICU) patients older than 2 months of age with a chlorhexidine preparation on a daily basis (B-II).
ÎUse antiseptic- or antimicrobial-impregnated central venous catheters for adult patients (A-I).
ÎUse chlorhexidine-containing sponge dressings for central venous catheters in patients older than 2 months of age (B-I).
ÎUse antimicrobial locks for central venous catheters (A-I).
* Recommended for all acute care hospitals. ** These special approaches are recommended for use in locations and/or populations within the hospital for which outcome data and/or risk assessment suggest lack of effective control despite implementation of basic practices.
