Central Line-Associated Bloodstream Infections (CLABSI)
ÎDifferential time to positivity (DTP) > 120 minutes of simultaneously drawn qualitative blood cultures from the central venous catheter and a vein suggests a CLABSI (A-II).
ÎFor CLABSI caused by S. aureus, P. aeruginosa, fungi, or mycobacteria, catheter removal is recommended in addition to systemic antimicrobial therapy for at least 14 days (A-II).
ÎCatheter removal is also recommended for tunnel infection or port pocket site infection, septic thrombosis, endocarditis, sepsis with hemodynamic instability, or bloodstream infection that persists despite ≥ 72 hours on appropriate antibiotics (A-II).
ÎFor documented CLABSI caused by coagulase-negative staphylococci, the catheter may be retained using systemic therapy with or without antibiotic lock therapy (B-III).
ÎProlonged treatment (4-6 weeks) is recommended for complicated CLABSI, defined as the presence of deep tissue infection, endocarditis, septic thrombosis (A-II) or persistent bacteremia or fungemia occurring > 72 hours after catheter removal on appropriate antimicrobials (A-II for S. aureus, C-III for other pathogens).
ÎPractice hand hygiene, maximal sterile barrier precautions, and cutaneous antisepsis with chlorhexidine for all central venous catheter insertions (A-I).
Environmental Precautions
ÎHand hygiene is the most effective means of preventing transmission of infection in the hospital (A-II).
ÎStandard barrier precautions should be followed for all patients and infection-specific isolation for patients suspected of having transmissable infections (A-III).
ÎHSCT recipients should be placed in private (ie, single-patient) rooms (B-III). Allogeneic HSCT recipients should be placed in rooms with > 12 air exchanges/hour and high-efficiency particulate air (HEPA) filtration (A-III).
ÎPlants and dried or fresh flowers should NOT be allowed in the rooms of hospitalized neutropenic patients (B-III).
ÎHospital work exclusion policies should be designed to encourage health care workers to report their illnesses or exposures (A-II).
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