The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practice Advisory Committee have realized updated guidelines for the prevention of intravascular catheter-related bloodstream infection.
The new guidelines which replace the recommendations published in 2002, place a heavy emphasis on the education and training of health care personnel, using chlorhexidine scrubs for skin antisepsis, ensuring a maximal sterile barrier for catheter insertions and avoiding the routine replacement of central venous catheters as an infection prevention strategy.
Central line associated bloodstream infections (CLABSIs), the most common type of nosocomial bloodstream infection, carry an estimated mortality rate of 12%-15%. The treatment of these infections costs US hospitals an estimated $29,000 per patient and $2.3 billion annually. These types of blood steam infections however are considered highly preventable when proper precautions are taken.
The updated guidelines included recommendations based on a five-step checklist that has been shown to be effective in preventing central line catheter infections. The checklist stresses hand hygiene, full barrier precautions during catheter insertion, chlorhexidine antisepsis at the insertion site, avoiding veins in the arm or leg, checking catheter lines each day and removing them when they are no longer needed.
A study of 103 ICUs in Michigan (N Engl J Med 2006; 355:2725-2732) found that the use of the checklist lead to a 66% reduction in CLABSIs after 18 months. After the realization that these infections could be prevented the Dept of Health and Human Services set a national goal of a 50% reduction in CLABSIs by 2013.
In 2008, the CMC designated CLABSIs a “never event” meaning hospitals will not receive additional reimbursements for treating the infections. Several commercial insurers have adopted this practice.