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Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

  • Jonas Marschall (a1), Leonard A. Mermel (a2), David Classen (a3), Kathleen M. Arias (a4), Kelly Podgorny (a5), Deverick J. Anderson (a6), Helen Burstin (a7), David P. Calfee (a8), Susan E. Coffin (a9), Erik R. Dubberke (a1), Victoria Fraser (a1), Dale N. Gerding (a10) (a11), Frances A. Griffin (a12), Peter Gross (a13) (a14), Keith S. Kaye (a6), Michael Klompas (a15), Evelyn Lo (a16), Lindsay Nicolle (a16), David A. Pegues (a17), Trish M. Perl (a18), Sanjay Saint (a19), Cassandra D. Salgado (a20), Robert A. Weinstein (a21), Robert Wise (a5) and Deborah S. Yokoe (a15)...

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line–associated bloodstream infection (CLABSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.

1. Patients at risk for CLABSIs in acute care facilities

a. Intensive care unit (ICU) population: The risk of CLABSI in ICU patients is high. Reasons for this include the frequent insertion of multiple catheters, the use of specific types of catheters that are almost exclusively inserted in ICU patients and associated with substantial risk (eg, arterial catheters), and the fact that catheters are frequently placed in emergency circumstances, repeatedly accessed each day, and often needed for extended periods.

b. Non-ICU population: Although the primary focus of attention over the past 2 decades has been the ICU setting, recent data suggest that the greatest numbers of patients with central lines are in hospital units outside the ICU, where there is a substantial risk of CLABSI.

2. Outcomes associated with hospital-acquired CLABSI

a. Increased length of hospital stay

b. Increased cost; the non-inflation-adjusted attributable cost of CLABSIs has been found to vary from $3,700 to $29,000 per episode

Corresponding author
University of Chicago Press, 1427 E. 60th St., Chicago, IL 60637 ( or contact the journal office (
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1. DG Maki , DM Kluger , CJ Crnich . The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:11591171.

2. F Esteve , M Pujol , E Limon , et al.Bloodstream infection related to catheter connections: a prospective trial of two connection systems. J Hosp Infect 2007;67:3034.

6. D Pittet , D Tarara , RP Wenzel . Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.

8. B Renaud , C Brun-Buisson , ICU-Bacteremia Study Group. Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:15841590.

9. JB Dimick , RK Pelz , R Consunji , SM Swoboda , CW Hendrix , PA Lipsett . Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg 2001;136:229234.

10. DK Warren , WW Quadir , CS Hollenbeak , et al.Attributable cost of catheter-associated bloodstream infection among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34:20842089.

11. LA Mermel . Prevention of intravascular catheter-related infections (published correction appears in Ann Intern Med 2000; 133:5). Ann Intern Med 2000;132:391402.

13. MA Almuneef , ZA Memish , HH Balkhy , O Hijazi , G Cunningham , C Francis . Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006;62:207213.

20. RJ Sherertz , EW Ely , DM Westbrook , et al.Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med 2000;132:641648.

22. P Pronovost , D Needham , S Berenholtz , et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.

23. SM Berenholtz , PJ Pronovost , PA Lipsett , et al.Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:20142020.

26. CM Coopersmith , TL Rebmann , JE Zack , et al.Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med 2002;30:5964.

27. DK Warren , JE Zack , MJ Cox , MM Cohen , VJ Fraser . An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center. Crit Care Med 2003;31:19591963.

28. DK Warren , JE Zack , JL Mayfield , et al.The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest 2004;126:16121618.

29. T Tsuchida , K Makimoto , M Toki , K Sakai , E Onaka , Y Otani . The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison. Int J Nurs Stud 2007;44:13241333.

31. G Yilmaz , I Koksal , K Aydin , R Caylan , N Sucu , F Aksoy . Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. JPEN J Parenter Enteral Nutr 2007;31:284287.

36. JJ Parienti , M Thirion , B Mégarbane , et al.Femoral versus jugular central catheterization in patients requiring renal replacement therapy: a randomized controlled study. JAMA 2008;299:24132422.

38. N Safdar , DG Maki . Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489495.

39. LA Mermel , RD McCormick , SR Springman , DG Maki . The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991;91:197S205S.

40. II Raad , DC Hohn , BJ Gilbreath , et al.Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15:231238.

41. KK Hu , BA Lipsky , DL Veenstra , S Saint . Using maximal sterile barriers to prevent central venous catheter-related infection: a systematic evidence-based review. Am J Infect Control 2004;32:142146.

42. EM Young , ML Commiskey , SJ Wilson . Translating evidence into practice to prevent central venous catheter-associated bloodstream infections: a systems-based intervention. Am J Infect Control 2006;34:503506.

43. DG Maki , M Ringer , CJ Alvarado . Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339343.

44. JS Garland , RK Buck , P Maloney , et al.Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J 1995;14:510516.

45. A Humar , A Ostromecki , J Direnfeld , et al.Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis 2000;31:10011007.

46. N Chaiyakunapruk , DL Veenstra , BA Lipsky , S Saint . Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002;136:792801.

48. MA Luebke , MJ Arduino , DL Duda , et al.Comparison of the microbial barrier properties of a needleless and a conventional needle-based intravenous access system. Am J Infect Control 1998;26:437441.

50. FA Lederle , CM Parenti , LC Berskow , KJ Ellingson . The idle intravenous catheter. Ann Intern Med 1992;116:737738.

51. CM Parenti , FA Lederle , CL Impola , LR Peterson . Reduction of unnecessary intravenous catheter use: internal medicine house staff participate in a successful quality improvement project. Arch Intern Med 1994;154:18291832.

52. DG Maki , SS Stolz , S Wheeler , LA Mermel . A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med 1994;22:17291737.

55. P Gastmeier , C Geffers , C Brandt , et al.Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 2006;64:1622.

58. A Levin , AJ Mason , KK Jindal , IW Fong , MB Goldstein . Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine. Kidney Int 1991;40:934938.

60. S Riu , CG Ruiz , A Martinez-Vea , C Peralta , JA Oliver . Spontaneous rupture of polyurethane peritoneal catheter: a possible deleterious effect of mupirocin ointment. Nephrol Dial Transplant 1998;13:18701871.

61. CE Lok , KE Stanley , JE Hux , R Richardson , SW Tobe , J Conly . Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol 2003;14:169179.

63. SC Bleasdale , WE Trick , IM Gonzales , RD Lyles , MK Hayden , RA Weinstein . Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:20732079.

64. DG Maki , SM Stolz , S Wheeler , LA Mermel . Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257266.

66. DL Veenstra , S Saint , S Saha , T Lumley , SD Sullivan . Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infections: a meta-analysis. JAMA 1999;281:261267.

67. RO Darouiche , II Raad , SO Heard , et al.A comparison of two antimicrobial-impregnated central venous catheters: Catheter Study Group. N Engl J Med 1999;340:18.

68. HA Hanna , II Raad , B Hackett , et al., M.D. Anderson Catheter Study Group. Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrug-resistant bacteremias in critically ill patients. Chest 2003;124:10301038.

70. ME Rupp , SJ Lisco , PA Lipsett , et al.Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med 2005;143:570580.

71. A Chelliah , KH Heydon , TE Zaoutis , et al.Observational trial of antibiotic-coated central venous catheters in critically ill pediatric patients. Pediatr Infect Dis J 2007;26:816820.

72. A Bhutta , C Gilliam , M Honeycutt , et al.Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 2007;334:362365.

73. JS Garland , CP Alex , CD Mueller , et al.A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107:14311436.

74. I Levy , J Katz , E Solter , et al.Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J 2005;24:676679.

75. KM Ho , E Litton . Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother 2006;58:281287.

79. L Labriola , R Crott , M Jadoul . Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant 2008;23:16661672.

80. AK Saxena , BR Panhotra , M Naguib . Sudden irreversible sensory-neural hearing loss in a patient with diabetes receiving amikacin as an antibiotic heparin lock. Pharmacotherapy 2002;22:105–8.

82. MR Ranson , BA Oppenheim , A Jackson , AG Kamthan , JH Scarffe . Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients. J Hosp Infect 1990;15:95102.

83. JA Sandoe , B Kumar , B Stoddart , et al.Effect of extended perioperative antibiotic prophylaxis on intravascular catheter colonization and infection in cardiothoracic surgery patients. J Antimicrob Chemother 2003;52:877879.

84. MD Van de Wetering , JBM van Woensel , LCM Kremer , HN Caron . Prophylactic antibiotics for preventing early Gram-positive central venous catheter infections in oncology patients, a Cochrane systematic review. Cancer Treat Rev 2005;31:186196.

85. S Eyer , C Brummitt , K Crossley , R Siegel , F Cerra . Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance. Crit Care Med 1990;18:10731079.

86. DK Cobb , KP High , RG Sawyer , et al.A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:10621068.

87. D Cook , A Randolph , P Kernerman , et al.Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 1997;25:14171424.

91. ME Rupp , LA Sholtz , DR Jourdan , et al.Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. Clin Infect Dis 2007;44:14081414.

94. PW Stone , C Mooney-Kane , EL Larson , et al.Nurse working conditions and patient safety outcomes. Med Care 2007;45:571578.

96. NE Soifer , S Borzak , BR Edlin , RA Weinstein . Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial. Arch Intern Med 1998;158:473477.

101. II Raad , M Baba , GP Bodey . Diagnosis of catheter-related infections: the role of surveillance and targeted quantitative skin cultures. Clin Infect Dis 1995;20:593597.

102. D Pittet , RP Wenzel . Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:11771184.

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