One of the essential practices for preventing
CLABSI recommended for all acutecare hospitals is using a ‘ prevention bundle ’ that focuses on catheter insertion . Studies have documented that use of such bundles is effective , sustainable , and costeffective .” morbidity and mortality . Evidence-based strategies are implemented to control and eliminate CLABSIs as well as other HAIs .
The Compendium stratifies its recommended strategies to prevent CLABSI as either essential practices that should be adopted by all acute-care hospitals or the aforementioned additional approaches that can be considered in locations and / or populations within hospitals when CLABSIs are not controlled by use of essential practices .
As the Compendium explains , “ Essential practices include recommendations in which the potential to affect CLABSI risk clearly outweighs the potential for undesirable effects . Additional approaches include recommendations in which the intervention is likely to reduce CLABSI risk but there is concern about the risks for undesirable outcomes , recommendations for which the quality of evidence is low , recommendations in which cost-to-benefit ratio may be high , or recommendations in which evidence supports the impact of the intervention in select settings ( during outbreaks ) or for select patient populations . Hospitals can prioritize their efforts by initially focusing on implementation of the prevention strategies listed as essential practices . If CLABSI surveillance or other risk assessments suggest ongoing opportunities for improvement , hospitals should consider adopting some or all the prevention approaches listed as additional approaches .”
One of the essential practices for preventing CLABSI recommended for all acute-care hospitals is using a “ prevention bundle ” that focuses on catheter insertion . Studies have documented that use of such bundles is effective , sustainable , and cost-effective . The Compendium notes that bundles are most likely to be successful “ if implemented in a previously established patient safety culture and their success depends on adherence to individual measures . However , data suggests that not all components of bundles may be necessary to achieve an effect on CLABSI rates .” Following catheter insertion , maintenance bundles have been proposed to ensure optimal catheter care ; however , the Compendium notes that additional data are needed to determine which components of the maintenance bundle are essential in reducing risk .
“ We do have data regarding the utilization of checklists and the different components of bundles to improve the overall care of patients in these settings ,” Cawcutt says . “ I think the distinction that sometimes is lost is that the checklist or the bundle are only as good as your implementation , dissemination , and maintenance of it . So , if you introduce it but no one uses it , of course , it doesn ’ t work . If you could introduce it and integrate it functionally into their workflow without making it overtly more difficult then will they work ? Absolutely , and I think that ’ s why it ’ s so important that there ’ s this additional infection for at the bottom , but particularly when you look at section 6 of the Compendium , you ’ re talking about how you integrate these and how do we support cultures that can functionally implement this work -- because telling people what to do or telling people these are your tasks that have to be done , but not making it easy to integrate into their work days means that it ’ s less likely to be done . With some of that evidence we do need to focus on how we integrate these high-level evidence items functionally with implementation and dissemination science .”
To review , the Compendium outlines key strategies for optimal line insertion , maintenance and removal .
Before insertion
➊ Provide easy access to an evidence-based list of indications for CVC use to minimize unnecessary CVC placement
➋ Require education and competency assessment of healthcare personnel ( HCP ) involved in insertion , care , and maintenance of CVCs about CLABSI prevention
➌ Bathe ICU patients older than 2 months of age with a chlorhexidine preparation daily
At insertion
➊ In ICU and non-ICU settings , a facility should have a process in place , such as a checklist , to ensure adherence to infection prevention practices at the time of CVC insertion
➋ Perform hand hygiene prior to catheter insertion or manipulation
➌ The subclavian site is preferred to reduce infectious complications when the catheter is placed in the ICU setting
➍ Use an all-inclusive catheter cart or kit
➎ Use ultrasound guidance for catheter insertion
➏ Use maximum sterile barrier precautions during CVC insertion
➐ Use an alcoholic chlorhexidine antiseptic for skin preparation
After insertion
➊ Ensure appropriate nurse-to-patient ratio and limit use of float nurses in ICUs
➋ Use chlorhexidine-containing dressings for CVCs in patients over 2 months of age
➌ For non-tunneled CVCs in adults and children , change transparent dressings and perform site care with a chlorhexidine-based antiseptic at least every seven days or immediately if the dressing is soiled , loose , or damp . Change gauze dressings every two days or earlier if the dressing is soiled , loose , or damp .
➍ Disinfect catheter hubs , needleless connectors , and injection ports before accessing the catheter
➎ Remove nonessential catheters
➏ Routine replacement of administration sets not used for blood , blood products , or lipid formulations can be performed at intervals up to seven days
➐ Perform surveillance for CLABSI in ICU and non-ICU settings
Performing these best practices requires proper resourcing , a fact not lost on the Compendium