Evidence-based guideline for CLABSI prevention, including insertion and maintenance bundles, supplemental strategies, diagnosis and management of catheter-related bloodstream infections, and surveillance.
A comprehensive, evidence-based clinical guideline for the prevention, diagnosis, and management of central line-associated bloodstream infections in critically ill patients. This resource synthesizes recommendations from the major national and international infection prevention organizations, healthcare epidemiology expert panels, quality improvement collaboratives, and infusion therapy professional societies into a single integrated reference for intensivists, infection preventionists, critical care nurses, vascular access teams, and hospital epidemiologists.1 2 3 4 5 6 7
Central line-associated bloodstream infections remain among the most common and costly healthcare-associated infections. An estimated 250,000 bloodstream infections occur annually in acute care facilities in the United States, with approximately 80,000 occurring in intensive care units. Each episode of CLABSI is associated with attributable mortality of 12–25%, excess hospital length of stay of 10–20 days, and incremental costs of $30,000–$45,000 per episode. Critically, strong evidence demonstrates that CLABSI is largely preventable through rigorous adherence to evidence-based insertion and maintenance bundles. Landmark quality improvement initiatives — including statewide collaborative programs and national safety campaigns — have demonstrated sustained reductions of 60–70% or more in CLABSI rates, bringing many ICUs to zero or near-zero infection rates for prolonged periods.
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | Definitions, Epidemiology & Pathogenesis | CLABSI vs CRBSI definitions; NHSN surveillance criteria; mucosal barrier injury CLABSI; epidemiology by ICU type; attributable mortality and costs; secular trends; pathogenesis of catheter colonization (extraluminal, intraluminal, hub contamination, hematogenous seeding); microbiology; risk factors |
| Part 2 | Insertion Bundle & Maintenance Bundle | Evidence-based insertion bundle (hand hygiene, maximal sterile barriers, chlorhexidine antisepsis, optimal site selection, daily necessity review); maintenance bundle (hand hygiene before access, scrub the hub, daily CHG bathing, dressing management, needleless connector care, administration set changes); evidence for each component |
| Part 3 | Supplemental Prevention Strategies, Diagnosis & Management of CRBSI | Antimicrobial-impregnated catheters; antimicrobial lock therapy; CHG-impregnated dressings; antibiotic ointments; diagnosis of CRBSI (paired blood cultures, differential time to positivity, catheter tip culture); empiric therapy; catheter removal vs salvage; duration of therapy by organism; complicated vs uncomplicated CRBSI; suppurative thrombophlebitis |
| Part 4 | Special Populations, Surveillance & Implementation Science | Neonates; immunocompromised patients; hemodialysis catheters; long-term catheters; NHSN surveillance methodology; SIR calculation; benchmarking; CUSP framework; daily goals checklist; nurse empowerment; team communication; zero CLABSI sustainability |
O’Grady NP, Alexander M, Burns LA, et al. “Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011.” Clin Infect Dis. 2011;52(9):e162-e193. DOI: 10.1093/cid/cir257 ↩︎
Marschall J, Mermel LA, Fakih M, et al. “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update.” Infect Control Hosp Epidemiol. 2014;35(7):753-771. DOI: 10.1086/676533 ↩︎
Buetti N, Marschall J, Drees M, et al. “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals: 2022 Update.” Infect Control Hosp Epidemiol. 2022;43(5):553-569. DOI: 10.1017/ice.2022.87 ↩︎
Pronovost P, Needham D, Berenholtz S, et al. “An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU.” N Engl J Med. 2006;355(26):2725-2732. DOI: 10.1056/NEJMoa061115 ↩︎
Institute for Healthcare Improvement. “How-to Guide: Prevent Central Line-Associated Bloodstream Infections (CLABSI).” Cambridge, MA: IHI; 2012. URL: https://www.ihi.org/resources/tools/how-to-guide-prevent-central-line-associated-bloodstream-infections ↩︎
Agency for Healthcare Research and Quality. “CUSP Toolkit — Eliminate CLABSI.” Rockville, MD: AHRQ; 2013. URL: https://www.ahrq.gov/hai/cusp/clabsi-702/index.html ↩︎
Gorski LA, Hadaway L, Hagle ME, et al. “Infusion Therapy Standards of Practice, 8th Edition.” J Infus Nurs. 2021;44(1S):S1-S224. DOI: 10.1097/NAN.0000000000000396 ↩︎
CLABSI prevention in neonates, immunocompromised patients, hemodialysis catheters, and long-term catheters; NHSN surveillance methodology; SIR calculation; CUSP framework; daily goals checklist; nurse empowerment; zero CLABSI sustainability.
Antimicrobial-impregnated catheters, antimicrobial lock therapy, CHG-impregnated dressings, antibiotic ointments, diagnosis of CRBSI (paired blood cultures, differential time to positivity, catheter tip culture), empiric therapy, catheter removal vs salvage, duration of therapy by organism, and suppurative thrombophlebitis.
Evidence-based insertion bundle components (hand hygiene, maximal sterile barriers, chlorhexidine antisepsis, site selection, daily necessity review) and maintenance bundle components (hub disinfection, CHG bathing, dressing management, needleless connectors, administration set changes) with supporting evidence.
CLABSI and CRBSI definitions, NHSN surveillance criteria, mucosal barrier injury CLABSI, epidemiology by ICU type, attributable mortality and costs, pathogenesis of catheter colonization, microbiology, and risk factors.