Table 2.
Infection Prevention Practices Included in Survey
| Practices to Prevent Central Line-Associated Bloodstream Infection1 | Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline Level of Evidence/Recommendation* | Part of the Institute for Healthcare Improvement (IHI) Central Line Bundle4 |
| Maximum barrier precautions (full gown, sterile gloves, full body sterile drape) during central catheter insertion | 1B† | Yes |
| Chlorhexidine gluconate for antisepsis of the insertion site | 1A | Yes |
| Antimicrobial central venous catheter | 1A†† | No |
| Antimicrobial dressing with chlorhexidine | 1B | No |
| Practices to Prevent Ventilator-Associated Pneumonia2 | Part of the Institute for Healthcare Improvement (IHI) Ventilator Bundle5 | |
| Semi-recumbent positioning of the patient (head of bed elevated 30 degrees or more) | II | Yes |
| Subglottic secretion drainage (via a special endotracheal tube) | II | No |
| Antimicrobial mouth rinse | II | Yes |
| Topical and/or systemic antibiotics for selective digestive tract decontamination | Unresolved | No |
| Practices to Prevent Catheter-Associated Urinary Tract Infection3 | Part of the Keystone Bladder Bundle6 | |
| Portable bladder ultrasound scanner for determining post-void residual | II | Yes |
| Urinary catheter reminder or stop-order | 1B | Yes |
| Antimicrobial urinary catheter | 1B | No |
| Condom catheters in men | II | Yes |
*HICPAC Level of Evidence/Recommendation:
Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
Category IB. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale; or an accepted practice (e.g., aseptic technique) supported by limited evidence.
Category IC. Required by state or federal regulations, rules, or standards.
Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.
Unresolved issue. Represents an unresolved issue for which evidence is insufficient or no consensus regarding efficacy exists.
†The recommendation for maximum sterile barriers changed from 1A in the 2002 recommendations to 1B in the 2011 recommendations.
††The recommendation for antimicrobial catheters changed from 1B in 2002 to 1A in 2011: Category IA
1O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. 2011. Available at: http://www.cdc.gov/HAI/bsi/bsi.html. Accessed October 13, 2011.
2Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1–36.
3Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31(4):319–26.
4Available at: http://www.ihi.org/explore/CentralLineInfection/Pages/default.aspx. Accessed October 13, 2011.
5Available at: http://www.ihi.org/knowledge/Pages/Changes/ImplementtheVentilatorBundle.aspx. Accessed October 13, 2011.
6Saint S, Olmsted RN, Fakih MG, et al. Translating Hospital-Associated Urinary Tract Infection Prevention Research into Practice via the Bladder Bundle. Joint Commission Journal on Quality and Patient Safety 2009; 25:449–455