HealthJune 01, 2022

Getting back to basics with preventing CLABSI

By: Collette Bishop Hendler, RN, MS, MA, CIC
Reports show central line-associated bloodstream infections (CLABSI) rose during the COVID-19 pandemic. To reduce cases, engage frontline staff with evidence-based guidelines and share infection data with other teams.

Reports show that central line-associated bloodstream infections (CLABSI) rose during the pandemic. One retrospective study compared CLABSI rates in 78 hospitals from a single health system during a 12-month period before the pandemic to the first six months of the pandemic and showed a 51% rise in CLABSI rates during the pandemic. (Fakih 2021) Moreover, the CDC’s National Healthcare Safety Network reported significant rises in the standardized infection ratio for CLABSI during the initial months of the pandemic. (Weiner-Lastinger 2021)

With personal protective equipment and other supply shortages, the focus on protecting staff from exposure, and the surge in critically ill patients, it’s no surprise that CLABSI rates climbed during the pandemic. Especially when CLABSI prevention success heavily relies on monitoring insertion processes and performing routine central line maintenance. As we move forward from this healthcare crisis, we need to get back to the basics with preventing CLABSI to ensure the safety of our patients. We were making great strides before the pandemic, so by refocusing, we can get back to achieving our CLABSI prevention goals. Share infection data with frontline staff and discuss the unit’s infection prevention goals, and then get back to basics.

New strategies to prevent CLABSI

So how do we get back to the basics? We can start by engaging staff with new evidence-based guidelines. In April, the Society for Healthcare Epidemiology of America (SHEA) released new practice recommendations for preventing CLABSI. SHEA developed the guidelines in collaboration with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission.

Four new essential CLABSI prevention practices

SHEA identified four essential practices that should now be implemented by all acute care facilities. Some were previously recommended as additional approaches for use when CLABSI rates weren’t under control; now they’re supported by greater evidence and universally recommended.

  1. Choose the subclavian vein for central line insertion in the critical care setting.
  2. Use ultrasound to guide catheter insertion.
  3. Apply a chlorhexidine-containing dressing over the insertion site
  4. Replace administration sets not used for blood, blood products, or lipid formulations at intervals of up to 7 days.

Additional strategies to prevent CLABSI

Next take the time to review with staff the other essential CLABSI prevention practices that helped reduce CLABSI infections before the pandemic.

Prior to CVC insertion

  • List the evidence-based indications for CLABSI insertion to prevent unnecessary central venous catheter (CVC) insertion. Make the list easily accessible to staff.
  • Teach and assess competency of all staff involved with CVC insertion and maintenance.
  • Bathe patients in the critical care unit who are older than 2 months with a chlorhexidine preparation daily. (Niccolò 2022)

During CVC insertion

  • Guide infection prevention practices during catheter insertion by using a check list (or other process).
  • Perform hand hygiene before insertion and catheter manipulation.
  • Employ an all-inclusive catheter kit or cart.
  • Utilize maximum sterile barrier precautions during CVC insertion.
  • Apply an alcohol-chlorhexidine antiseptic for skin preparation. (Niccolò 2022)

After CVC insertion

  • Make sure you have an appropriate nurse-to-patient ratio in the critical care unit and limit the use of float nurses; inappropriate nurse-to-patient ratios and float staff have been associated with higher CLABSI rates. (Fridkin 1996, Cimiotti 2006)
  • Perform site care with a chlorhexidine-based antiseptic.
  • Change the transparent dressing (for non-tunneled CVCs) at least every 7 days or immediately if the dressing becomes damp, loose, or soiled. Change gauze dressings every 2 days or when damp, loose, or soiled.
  • Disinfect catheter hubs, needleless connectors, and injection ports before accessing the CVC.
  • Remove any CVC that’s no longer essential for the patient’s care.
  • Surveil acute care settings for CLABSI (critical care and noncritical care). (Niccolò 2022)

Fight back and celebrate successes

If CLABSIs still aren’t under control in certain patient populations or care areas in your facility after reviewing and implementing essential practices, fight back by implementing these additional strategies.

  • Utilize antimicrobial- or antiseptic-impregnated CVCs.
  • Lock long-term CVCs with an antimicrobial lock solution.
  • Employ a vascular access or infusion team.
  • Apply antimicrobial ointment to hemodialysis catheter insertion sites.
  • Cover connectors with an antiseptic-containing protector. (Niccolò 2022)

After getting back to basics, continue to share infection data with staff. As infections drop, celebrate successes, and share your success stories for reducing CLABSI in your facility with others so they can learn and implement best practices.

Learn how Lippincott Solutions can support ongoing clinical learning and point of care best practices for your nursing teams.

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Collette Bishop Hendler, RN, MS, MA, CIC
Editor-in-Chief, Lippincott Solutions, Point-of-Care, Wolters Kluwer Health
Collette is certified by the Certification Board of Infection Control and Epidemiology, Inc. as an infection preventionist. She has more than 15 years of experience in critical care nursing and maintains Alumnus Status as a Critical-Care Registered Nurse.
  1. Cimiotti, J.P., et al. (2006). Impact of staffing on bloodstream infections in the neonatal intensive care unit. Archives Pediatric Adolescent Medicine, 160, 832–836.
  2. Fakih, M.G., et al. (2021). Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts. Infection Control & Hospital Epidemiology, 43, 26-31.
  3. Fridken, S.K., et al. (1996). The role of understaffing in central venous catheter-associated bloodstream infections. Infection Control & Hospital Epidemiology, 17, 150–158.
  4. Niccolò, B. et al. (2022). SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43, 553-569.
  5. Weiner-Lastinger, L.M., et al. (2021). The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network. Infection Control & Hospital Epidemiology, 43, 12-25.
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