Guidelines on Bloodstream Infections Updated

To succinctly highlight practical recommendations that can help acute-care hospitals implement and prioritize infection prevention efforts, the Society for Healthcare Epidemiology of America (SHEA) sponsored a 2022 update to the 2014 version of Strategies to Prevent Central Line-Associated Bloodstream Infections [CLABSIs] in Acute-Care Hospitals. The update is the product of a collaboration between SHEA and the Infectious Diseases Society of America, the Association for Professional in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission on Hospital Accreditation.

Recommendations are categorized as essential practices that should be adopted by all acute-care hospitals or additional approaches for use in hospitals when CLABSIs remain uncontrolled after essential practices have been implemented.

To reduce infectious complications, the subclavian vein is now considered the preferable site for central venous catheter insertion in the intensive care unit. The previous recommendation to use ultrasound guidance for catheter insertion is supported by better evidence than was previously available. The use of chlorhexidine dressings is now considered an essential practice, and routine replacement of administration sets not used for blood, blood products, or lipid formulation can be done at intervals of up to 7 days rather than within the previous limit of no longer than 4 days.

Additional approaches include the use of antimicrobial ointment for the catheter site in hemodialysis patients, the use of antiseptic-containing caps (which are not considered better than manual disinfection, an essential practice), the importance of infusion teams, and sutureless securement of catheters.

“No guideline or expert guidance document can anticipate all clinical situations, and this document is not meant to be a substitute for individual clinical judgment by qualified professionals,” authors noted.

—Ellen Kurek

Reference:

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. 2022:1-17. doi:10.1017/ice.2022.87