Prevention of Central Line–Associated Bloodstream Infections

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Key points

  • The incidence of central line–associated bloodstream infection (CLABSI) has decreased with the implementation of evidence-based practice guidelines.

  • Clinical factors that may reduce the risk of CLABSI include catheter choice, catheter site selection, insertion technique, and catheter maintenance.

  • Newer technology, such as needleless securement devices and disinfecting caps, have been shown to be additional effective strategies to further reduce the incidence of CLABSI.

Definitions

There are 2 major definitions used to describe bloodstream infections related to CVCs: catheter-related bloodstream infection (CRBSI) and central line–associated bloodstream infection (CLABSI). CRBSI is a clinical definition based on clinical criteria related to a specific patient in whom the diagnosis is being considered. This definition is more often used for research, and in some cases of clinical care, because it requires specialized microbiological techniques to specifically identify the

Closed intensive care unit versus open intensive care unit

Intensive care is frequently practiced in a multidisciplinary fashion, in which the primary treatment team is tasked with providing care for patients with the input from specialty providers, pharmacists, therapists, nutritionists, and other health care professionals. Such an environment can lead to differing opinions on the approach to care and methods to implement plans of care. In an effort to centralize critical decision making for critically ill patients and standardize care, many intensive

Summary

Preventing CLABSIs in the ICU usually requires multiple strategies. Insertion strategies including education and training of those who insert catheters, use of chlorhexidine for skin antisepsis, and use of maximal sterile barrier precautions have a long record of preventing CLABSI. Novel technologies, such as antibiotic-impregnated or antiseptic-impregnated catheters, SSDs, and disinfection caps, should be added to the armamentarium of tools to further reduce CLABSI rates.

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    Disclosures: This work was supported by the National Instituted of Health, Clinical Center. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institutes of Health, or the Department of Health and Human Services.

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