Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update

PurposePreviously published guidelines provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs).The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts.This document updates the Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals published in 2014. 1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA).It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. Summary of major changesThis section lists major changes from the Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals: 2014 Update, 1 including recommendations that have been added, removed, or altered.Recommendations are categorized as essential practices that should be adopted by all acute-care hospitals (in 2014 these were “basic practices,” renamed to highlight their importance as foundational for hospitals’ HAI prevention programs) or additional approaches that can be considered for use in locations and/or populations within hospitals when CLABSIs are not controlled after implementation of essential practices (in 2014 these were “special approaches”).See Table 1 for a complete summary of the recommendations contained in this document. Essential practices• The subclavian vein is considered the preferable site for central venous catheter (CVC) insertion in the intensive care setting to reduce infectious complications.Previously, the primary recommendation was to avoid the femoral vein for access.Although this remains valid, it has been replaced by a positively formulated recommendation regarding the subclavian site.• The recommendation to use ultrasound guidance for catheter insertion is backed by better evidence than was available previously; however, the procedure itself may jeopardize the strict observation of sterile technique.• The use of chlorhexidine-containing dressings is now considered an “essential practice”; in the past, it was listed under special approaches that should only be employed if CLABSI rates remain high despite the implementation of basic practices.• Routine replacement of administration sets not used for blood, blood products, or lipid formulations can be performed at