Preventing health-care–associated infections in acute-care hospitals is crucial for patient well-being and health care cost burden, and comprehensive guidelines based on current research are an important aspect of prevention.
Taking measures to prevent health-care–associated infections (HAIs), including central line-associated bloodstream infections (CLABSIs), is crucial in acute-care hospital settings. A recent update to CLABSI prevention guidelines, first published in 2014, highlights patient risk factors and on-site strategies to help prevent the spread of CLABSIs in hospitals.
The Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals guidelines are the product of a collaborative effort between the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and sources from various organizations and societies with relevant expertise.
The CLABSI guidelines are part of a series of practice recommendations for health-care–associated infection prevention, the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates.
Patients who acquire CLABSIs are generally hospitalized longer, have increased care costs, and increased morbidity and mortality. Minimizing the likelihood of infection in high-risk patients, including those in the intensive-care unit (ICU) with a central venous catheter (CVC) in place, is key for health care burden and patient outcomes.
In the updated guidelines, recommended best practices for hospitals were deemed “essential practices,” to note them as key aspects of HAI prevention, whereas in 2014 they were referred to as “basic practices.” Practices termed “special approaches” in 2014 were renamed “additional approaches,” and provide options for when essential practices fail to control CLABSIs.
Updates to essential practices include:
Changes to additional approaches include:
Two approaches the guidelines recommend avoiding are using antimicrobial prophylaxis for short-term or tunneled catheter insertion or while catheters are in situ, and routinely replacing CVCs or arterial catheters. Some issues remain unresolved, such as the use of needleless connectors, sutureless securement, and CLABSI risk associated with non-antimicrobial transparent dressings.
Regular updates to and adoption of these research-backed recommendations are of the utmost importance to avoid preventable CLABSIs in the acute-care hospital setting.
“Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years, the rates of CLABSIs and several other healthcare-associated infections have substantially worsened during the COVID-19 pandemic, reversing years of progressive improvement,” Deborah Yokoe, MD, MPH, the SHEA chair of the Compendium, said in a statement. “These infections seriously threaten patients’ lives and recovery, and the rising rates are further evidence for the need to build more resilient systems of care. The Compendium is foundational for helping hospitals do this.”
Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. Published online April 19, 2022. doi:10.1017/ice.2022.87