The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal. Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs). We now can appreciate that the approach to reducing CLABSIs much include BOTH rigorous attention to sterile precautions during the central line placement process, but also a strict catheter maintenance protocol.
The CDC and IHI protocol for central line insertion has now become standard practice and includes the following components:
- Good handwashing
- Clinicians must wear a cap and a mask
- Cleanse the skin with chlorhexidine and allow a couple of minutes to fully dry before the sterile drape is applied.
- Operator must wear a sterile gown and gloves
- Wide sterile barrier that covers the entire bed
- An antimicrobial-impregnated catheter should be used
- An observer wearing a cap and mask should monitor the entire procedure and stop the procedure for any breaks in sterile technique
- Wide sterile occlusive dressing is used to cover the insertion site.
This study was a prospective trial in a cancer unit that analyzed whether the use of disinfection hubs over the catheter ports decreased the incidence of CLABSI any further compared with strict insertion practices alone. The investigators found that the incidence of CLABSI was decreased by about 1/3 with an OR=0.62 and the annual institutional savings with this intervention was about $3,250,000.
In addition to this intervention, a careful catheter maintenance protocol should mandate that all providers must wash their hands in advance and wear gloves and preferably masks when accessing the catheter ports. In addition, the sterile occlusive dressing should be checked regularly to make sure all edges are firmly sealed and the dressings should be changed regularly.
