Table 51-12.

Summary of CDC/HICPAC Guideline for Prevention of IVD-Related Bloodstream Infection

Recommendation	Strength of Evidence*
General measures
▪Educate all health care workers involved with IVD care and maintenance	IA
▪Ensure adequate nursing staffing levels in ICUs	IB
Surveillance
▪Monitor institutional IVD infection rates of IVD-related BSI	IA
▪Express rates of CVC-related BSI per 1000 CVC-days	IB
At-catheter insertion
▪Aseptic technique:
Hygienic hand care before insertion or manipulation of any IVD	IA
Clean or sterile gloves during insertion and manipulation of noncentral IVDs	IC
Maximal barrier precautions during insertion of CVCs: mask, cap, sterile gown, gloves, drapes	IA
▪Dedicated IVD team strongly recommended	IA
▪Cutaneous antisepsis: first choice, chlorhexidine; however, tincture of iodine, an iodophor, or 70% alcohol are accepTable (no recommendations for use of chlorhexidine in infants younger than 2 months, unresolved issue)	IA
▪In adults, other than hemodialysis catheters (jugular site preference), use a subclavian site rather than a jugular or femoral site for CVC access (in pediatric patients, no recommendations for preferred site, unresolved issue)	IA
▪Use of sutureless securement device	NR
▪Sterile gauze or a semipermeable polyurethane dressing to cover site	IA
▪No systemic or topical antibiotics at insertion	IA
Maintenance
▪Remove IVD as soon as no longer required	IA
▪Monitor IVD site daily	IB
▪Change dressing of CVC insertion site at least weekly	II
▪Do not use topical antibiotic ointments	IA
▪Change needless IV systems at least as frequently as the administration set; replace caps no more frequently than every 3 days or per manufacturer's recommendations	II
▪Complete lipid infusions within 12 hr	IB
▪Replace administration sets no more frequently than every 72 hr. When lipid-containing admixtures or blood products are given, sets should be replaced every 24 hr; with propofol, every 6-12 hr	IA
▪Replace peripheral IVs every 72-96 hr	IB
▪Do not routinely replace CVCs or PICCs solely for prevention of infection	IB
▪Do not remove CVCs or PICCs solely because of fever unless IVD infection is suspected, but replace catheter if there is purulence at the exit site, especially if the patient is hemodynamically unsTable and IVD-related BSI is suspected	II
Technology
▪Use antimicrobial-coated or antiseptic-impregnated CVC in adult patients if institutional rate of BSI is high despite consistent application of preventive measures and catheter likely to remain in place >5 days (no data or recommendations for pediatric patients)	IB
▪Use chlorhexidine-impregnated sponge dressing for adolescent or adult patients with uncuffed CVCs or other catheters likely to remain in place >5 days (no recommendation for children, do not use in neonates younger than 7 days old or gestational age younger than 26 wk)	NR
▪Use prophylactic antibiotic lock solution only in patients with long-term IVDs who have continued to experience IVD-related BSIs despite consistent application of infection control practices	II

BSI, bloodstream infection; CVC, central venous catheter; ICU, intensive care unit; IV, intravenous; IVD, intravascular device.

^*Taken from CDC/HICPAC system of weighting recommendations based on scientific evidence. IA, strongly recommended for implementation and supported by well-designed experimental, clinical, or epidemiological studies. IB, strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale. IC, required by state or federal regulations, rules, or standards. II, suggested for implementation and supported by suggestive clinical or epidemiological trials or a theoretical rationale. Unresolved issue, an unresolved issue for which evidence is insufficient or no consensus regarding efficacy exists. NR, no recommendation for or against at this time.

Modified from O'Grady NP, Alexander M, Dellinger EP, et al: Guidelines for ns. Clin Infect Disthe prevention 2002;35:1281-1307.

© 2008