What is the latest Central Line-Associated Bloodstream Infection (CLABSI) guideline for preventing and managing CLABSI in patients with central lines?

Latest CRBSI/CLABSI Guideline

The most recent guideline is the 2024 International Society for Infectious Diseases (ISID) position paper on preventing central line-associated bloodstream infections, published in 2025 in the International Journal of Infectious Diseases. 1

Key Updates from the 2024 ISID Guideline

The ISID guideline represents a comprehensive update covering literature from January 2014 through June 2024, with recommendations organized into nine distinct categories to guide clinical practice. 1

Necessary Prerequisites for CLABSI Prevention Programs

Before implementing prevention strategies, healthcare facilities must establish:

• Education and training infrastructure with dedicated resources 1
• Infection prevention team capable of identifying patients meeting CLABSI definitions 1
• Information technology support for tracking central line-days and patient-days to calculate device utilization ratios 1
• Validation systems that compare automated CL-day counts to manual methods, with acceptable error margins not exceeding ±5% 1
• Laboratory support for timely specimen processing and result reporting 1

Core Prevention Strategy: Multidimensional Approach

The guideline mandates implementing six simultaneous components:

1. Evidence-based care bundles 1
2. Comprehensive education programs for healthcare professionals, patients, and caregivers 1
3. CLABSI surveillance using CDC/NHSN uniform methods and definitions 1
4. Compliance monitoring with recommended practices 1
5. Internal rate reporting stratified by unit type 1
6. Performance feedback to clinical teams 1

This approach has demonstrated effectiveness across 30 countries, reducing CLABSI rates from 15.34/1,000 CL-days to 2.23/1,000 CL-days over 29 months. 1

Insertion Bundle Requirements

All healthcare providers must wear mask, cap, sterile gown, and sterile gloves, with the patient covered by a large sterile drape. 2

• Perform hand hygiene before insertion or manipulation using alcohol-based hand rub or soap and water, regardless of glove use 2
• Use 2% alcoholic chlorhexidine for skin antisepsis, allowing complete drying before insertion 2
• Avoid femoral vein placement when possible, as peripherally inserted central catheters (PICCs) demonstrate the lowest CLABSI risk 1, 2
• Apply ultrasound guidance for internal jugular and femoral vein catheterization to reduce complications 2

Maintenance Bundle Components

Review central line necessity daily and remove promptly when no longer needed. 2

• Use transparent semipermeable dressings replaced every 7 days, or chlorhexidine-impregnated dressings for patients over two months of age 2
• Replace dressings immediately if soiled, loose, or damp 2
• Disinfect catheter hubs and needleless connectors before each access using alcoholic chlorhexidine or 70% alcohol with mechanical friction 2
• Provide daily chlorhexidine bathing for ICU patients over two months of age (avoid in infants under two months due to skin injury risk) 2

Surveillance Methodology

Calculate CLABSI rates as the number of infections divided by total CL-days, multiplied by 1,000. 1

• Stratify rates by patient-care unit type for meaningful comparisons 1
• Monitor CL-device utilization ratios longitudinally to identify variations 1
• Extend surveillance to all catheter types including peripheral arterial catheters, short-term peripheral venous catheters, and midline catheters 1
• Count central line-days based on physical patient location, not service attribution 3

Education and Competency Requirements

Mandate education and competency assessments for all healthcare professionals involved in CL insertion, care, and maintenance. 1, 2

This includes understanding appropriate insertion indications, implementing prevention recommendations, and conducting daily assessments of ongoing CL necessity. 1

Practices to Avoid

• Do not routinely replace central lines or arterial catheters 2
• Avoid systemic antimicrobial prophylaxis during short-term tunneled catheter insertion or while catheters remain in place 2

Resource-Limited Settings Adaptations

• Use collapsible closed-system IV fluid containers instead of open-system rigid containers 2
• Use needleless connectors instead of three-way stopcocks, preferring positive displacement types 2
• Follow the INICC Multidimensional Approach, which has demonstrated significant reductions in limited-resource settings 2

Important Context

The 2011 CDC guidelines remain foundational, but the 2024 ISID update incorporates a decade of additional evidence and addresses implementation challenges across diverse healthcare settings. 1 The guideline acknowledges that CLABSI measurement methodology remains imperfect, with significant underreporting of complications occurring outside monitored venues. 1 Despite this limitation, standardized surveillance using the ISID framework enables meaningful quality improvement when applied consistently. 1