What can help prevent catheter line associated bloodstream infection at the time of insertion?

Preventing Catheter Line-Associated Bloodstream Infections During Insertion

To prevent catheter line-associated bloodstream infections (CLABSI) at the time of insertion, healthcare providers should implement maximum sterile barrier precautions, use chlorhexidine-based skin antisepsis, perform proper hand hygiene, and select appropriate insertion sites while avoiding the femoral vein when possible. 1

Essential Preventive Measures During Insertion

Hand Hygiene

• Perform proper hand hygiene with antiseptic-containing soap and water or alcohol-based hand rubs before and after catheter insertion 1
• Remember that wearing gloves does not eliminate the need for hand hygiene 1

Maximum Sterile Barrier Precautions

• Use maximum sterile barrier precautions including cap, mask, sterile gown, sterile gloves, and a sterile full-body drape during central line insertion 1
• Ensure all healthcare personnel involved in the insertion procedure adhere to these precautions 1

Skin Antisepsis

• Apply an alcoholic chlorhexidine solution containing a minimum of 2% chlorhexidine to the insertion site 1
• Allow the antiseptic to completely dry according to manufacturer's recommendations before making the skin puncture 1
• If chlorhexidine is contraindicated, alternatives include tincture of iodine, an iodophor, or 70% alcohol 1
• Note that no recommendation can be made for chlorhexidine use in infants under 2 months of age due to safety concerns 1

Insertion Site Selection

• Avoid using the femoral vein for central line placement when possible, especially in ICU settings 1, 2
• Consider subclavian vein as the preferred site for non-tunneled catheters to minimize infection risk 1, 2
• For infants, if upper body sites are contraindicated, tunneled femoral vein catheters with an exit site outside the diaper area may be considered 1

Education and Training Requirements

• Ensure all healthcare personnel involved in catheter insertion and maintenance complete comprehensive education on CLABSI prevention 1
• Conduct periodic assessments of healthcare workers' knowledge and adherence to preventive measures 1
• Implement a credentialing process to verify competence in catheter insertion and maintenance of aseptic technique 1
• Consider simulation training for accurate catheter insertion procedures 1, 3

Post-Insertion Care to Prevent Infection

Dressing Management

• Cover the catheter site with either sterile gauze or sterile, transparent, semi-permeable dressing 1
• Use gauze dressings if the patient is diaphoretic or if the site is bleeding or oozing 1
• Replace gauze dressings every 2 days and transparent dressings at least every 7 days 1
• Change dressings immediately if they become damp, loosened, or visibly soiled 1

Daily Patient Care

• Consider daily chlorhexidine bathing for ICU patients over 2 months of age 1
• Perform daily assessment of the continued need for the catheter, with prompt removal when no longer essential 1, 3
• Replace catheters inserted during emergency situations (when aseptic technique cannot be ensured) within 48 hours 1

Catheter Hub and Port Management

• Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter 1, 4
• Consider using antiseptic-containing caps or port protectors to cover needleless connectors 1, 4

Common Pitfalls and How to Avoid Them

• Failing to allow antiseptic solution to completely dry before catheter insertion reduces its effectiveness 1, 5
• Improper handling of the catheter hub during connection/disconnection can lead to intraluminal contamination 6
• Submerging catheters underwater increases infection risk; protect catheters during showering 1, 7
• Keeping catheters in place longer than clinically necessary increases infection risk 1, 3

Special Considerations

• For high-risk patients or facilities with high CLABSI rates despite basic preventive measures, consider using chlorhexidine-impregnated sponge dressings for temporary short-term catheters 1, 4
• In resource-limited settings, consider using closed-system collapsible IV fluid containers and needleless connectors instead of three-way stopcocks 1
• Avoid routine administration of systemic antimicrobial prophylaxis during catheter insertion 1, 8