Table 2.

Key elements in the CCHMC CA-BSI insertion and maintenance bundles.

Insertion bundle

(1) Strict hand hygiene

(2) Full sterile barrier precautions

(a) Catheter insertion training for all credentialed providers

(b) Fully stocked insertion bin/cart

(c) Sterile gown, hat, mask, gloves worn by provider inserting the line

(d) Large sterile drape covering 80–100% of the patient and bed

(3) Chlorhexidine skin scrub at insertion site (2 minute scrub, 1 minute air-dry)

(4) Chlorhexidine-impregnated sponge placed at insertion site

(5) Insertion checklist

(6) Staff empowerment to stop procedure, if necessary

Maintenance bundle

(1) Strict hand hygiene

(a) Hand washing or use of an alcohol-based hand gel by all personnel prior to any catheter care

(b) Wear gloves for all catheter manipulations, medication administration, and so forth

(2) Catheter site care

(a) Change clear dressing every 7 days unless visibly soiled, loosened, or dampened

(b) Change sterile gauze dressing every 2 days unless visibly soiled, loosened, or dampened

(c) Chlorhexidine scrub to site with dressing changes (30 second scrub followed by 30-second air-dry)

(d) No iodine ointment at site

(e) Chlorhexidine-impregnated sponge placed at insertion site with every dressing change

(f) Prepackaged dressing change kit used for all dressing changes

(3) Catheter/hub/cap/tubing care

(a) Replace continuous administration sets no more frequently than every 72 hours (no less frequently than every 96 hours), unless   visibly soiled or contaminated

(b) Replace intermittent administration sets every 24 hours or sooner if visibly soiled or contaminated

(c) Replace tubing used to administer blood, blood products, or lipids within 24 hours of initiating infusion

(d) Cap change every 7 days and within 24 hours of blood product administration (sooner if visibly soiled or contaminated)

(e) Prepackaged cap change kit

(4) Daily discussion of line necessity and integrity