Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

Abstract

Previously published guidelines are available that 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 “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis

“…Each ICU must assess the potential benefit of instituting daily CHG bathing to reduce infections in the ICU such as CLABSI and MRSA. For instance, in an ICU with specific bundles to prevent CLABSI, such as those developed by Pronovost [7, 27], baseline rates of CLABSI may be fewer than 1 per 1000 central-line-days, and the NNT in the order of 1800 patients being bathed daily with CHG to prevent one case of CLABSI. Any benefit from the widespread use of CHG bathing in the ICU should consider the prevalence of central line catheters in a given ICU setting.…”

“…Patients cared for in the ICU are at increased risk of HAI due to the invasive nature of many treatments such as mechanical ventilation, urinary catheterisation, and central venous access. Efforts have been made to reduce hospital-acquired infections among adult intensive care patients, including increased hand hygiene, bundles for insertion of vascular access devices, the screening and isolation of patients colonised with multidrug-resistant organisms, and decontaminating the skin with chlorhexidine (CHG) [6, 7]. …”

Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial

“…Furthermore, full barrier protection and close inspection for any early infection signs help to prevent CRBSI [5, 15, 16]. Regular training on hygiene measures and infection prevention also lowers the amount of CRBSI [17, 18].…”

“…The minimization of catheter-surrounding skin recolonization is an effective step to avoid these infections [4], which are associated with many consecutive risks and cause an increase in treatment costs and lengths of stay [5]. As the amount of skin colonization is directly associated with catheter colonization and therefore with CRBSI risk, it is essential to focus on continuous skin hygiene [6].…”

Journal Roundup

“…21 The update of the 'Compendium of strategies to prevent healthcare-associated infection' continues in ICHE, with the publication of revised guidelines for central line-associated bloodstream infection and meticillin-resistant S. aureus. 22,23 The accompanying editorial raises some questions about whether a 'vertical' (i.e. targeted) or 'horizontal' (i.e.…”