Strategies to prevent CABSI

• Use a central-line bundle kit to reduce CABSI. This approach has proven to be effective for a number of organizations. Instructions for implementing the change in your organization can be found at http://www.ihi.org/IHI/Programs/Campaign/CentralLineInfection.htm.
• Provide staff training and education on catheter insertion and site care. Standardize how staff insert and care for CVCs.
• Have staff demonstrate competency in catheter insertion and site care.
• Require staff credentialing in CVC insertion, which ensures that staff are knowledgeable about insertion techniques.
• Provide a checklist of the steps for CVC insertion and site care. This checklist will serve as a reminder to staff and ensure that no steps are missed.
• Require monitoring, measuring, and providing feedback of results to individuals involved in this aspect of patient care. This will increase the likelihood of improvement.

Special strategies have been recommended for use in populations or locations with an unacceptably high rate of CABSI that is not declining with the use of current prevention strategies:

• Use antiseptic or antimicrobial-impregnated CVCs in adult patients. The risk of CABSI has been reduced with the use of some CVCs impregnated with antiseptics such as chlorhexidine-silver sulfadiazine and antimicrobials such as minocycline-rifampin.7,19,20 Rather than for routine use as a preventive measure, these catheters are recommended for patients with poor venous access and a history of recurrent CABSI, and for patients with a high risk for severe illness if they acquire a CABSI (e.g., heart surgery patients). Such catheters are not approved for use in children.12
• Use a chlorhexidine sponge dressing for CVCs in patients older than 2 months.13,21This is a small disc that is placed around the catheter at the exit site, is covered with a transparent dressing, and is changed every 7 days according to manufacturer’s recommendations. Of note, there are also new chlorhexidine dressing products available such as a transparent dressing with a chlorhexidine gel built in. Chlorhexidine-impregnated dressings are effective in reducing bacterial colonization at both vascular and epidural sites and have also been identified with a trend towards reduction of catheter-related bloodstream infections.22 However, organizations that have implemented the fundamental components of the central line bundle have been able to reduce CABSI without these specialty dressings. The dressings are currently recommended for patients with poor venous access and a history of recurrent CABSI or for those with a high risk for severity of illness if they acquire a CABSI.12