SHEA Updates Guidelines for Central Line-Associated Bloodstream Infection Prevention in Hospitals

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:

• "The subclavian site is preferred to reduce infectious complications when the catheter is placed in the intensive-care unit.” Previous guidelines recommended avoiding the femoral vein for access. This is still best practice but was replaced by the positive recommendation of the subclavian site.
• “Use ultrasound guidance for catheter insertion.” There is higher quality evidence than was available previously, but this procedure could potentially jeopardize the ability to ensure sterile technique.
• “Use chlorhexidine-containing dressings for CVCs in patients over 2 months of age,” was previously a special approach but is now an essential practice.
• “Routine replacement of administration sets not used for blood, blood products, or lipid formulations can be performed at intervals of up to 7 days.” The interval was up to 4 days in previous guidelines.

Changes to additional approaches include:

1. “Use antimicrobial ointments for hemodialysis catheter insertion sites,” was switched from an essential practice to additional approach considering its specificity.
2. “Use antiseptic-containing hub/connector cap/port protector to cover connectors,” is still not considered a better method than manual disinfection despite high-quality evidence, so it is still categorized as an additional approach.
3. “Use infusion or vascular access teams for reducing CLABSI rates,” was considered an unresolved issue in previous guidelines but is now an additional approach.

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.”

Reference

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