Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

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Abstract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). 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. This document updates "Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals," 1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates. 2 section 2: background-strategies to detect clabsi I. Surveillance protocol and definition of CLABSIs A. Use consistent surveillance methods and definitions to allow comparison to benchmark data. B. Refer to the National Healthcare Safety Network (NHSN) Manual: Patient Safety Component Protocol for information on the appropriate surveillance methodology, including information about blood specimen collection, and for surveillance definitions of CLABSIs. The relevant sections of the manual are "Identifying Healthcare-Associated Infections (HAI) in NHSN," "Device-Associated Module: Methodology," and "Device-Associated Module: Central Line-Associated Bloodstream Infection (CLABSI) Event." 31 1. Recent data suggest that interrater reliability using NHSN definitions is lower than expected. 32-34 This may also affect the reliability of public reporting. Additionally, the NHSN surveillance definition for CLABSI is different from the clinical definition for catheterrelated bloodstream infection. 35 section 3: background-strategies to prevent clabsi I. Existing guidelines and recommendations A. Several governmental, public health, and professional organizations have published evidence-based guidelines and/or implementation aids regarding the prevention of CLABSI, including the following: 1. The Healthcare Infection Control Practices Advisory Committee (HICPAC), Centers for Disease Control and Prevention 36,37 2. The Institute for Healthcare Improvement 38 3. The Agency for Healthcare Research and Quality 39 4. The American Pediatric Surgical Association Outcomes and Clinical Trials Committee 40 5. The Joint Commission 41 6. APIC 42 7. The Infusion Nurses Society 43 B. The recommendations in this document focus on CVCs unless noted otherwise. These recommendations 1. Are not stratified on the basis of catheter type (eg, tunneled, implanted, cuffed, noncuffed catheter, and dialysis catheter) and 2. May not be applicable for prevention of bloodstream infections with other intravascular devices. II. Infrastructure requirements include the following: A. An adequately staffed infection prevention and control program responsible for identifying patients who meet the surveillance definition for CLABSI. B. Information technology to collect and calculate catheter-days as a denominator when computing rates of CLABSI and patient-days to allow calculation of CVC utilization. Catheter-days from information systems should be validated against a manual method, with a margin of error no greater than .%5 C. Resources to provide appropriate education and training. D. Adequate laboratory support for timely processing of specimens and reporting of results.

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