Table 2.

Prevention strategies

	Insertion bundle	Maintenance bundle
CLABSI [17]	- Strict asepsis - Use of 2% chlorhexidine skin preparations - Ultrasound guidance by an experienced provider (reduces the number of attempts) - Preferring the subclavian vein, when possible, for nontunnelled catheters - Prompt removal of any line when no longer required - Usage of a checklist	- Daily assessment of the need for the central line - Disinfection of the catheter hubs, injection ports, and connections before accessing the line - Change of gauze dressings every 2 d unless soiled, dampened, or loosened (CDC recommended) - Change of clear dressing every 7 d unless soiled, dampened, or loosened (CDC recommended) - Replacing administration sets other than sets used for lipids or blood products every 72–96 h - Replace tubing used to administer blood, blood products, or lipids within 24 h after initiation of infusion (CDC recommended) - Change caps no more often than 72 h and when the administration set is changed
VAP [8]	- Avoid invasive ventilation - Prefer noninvasive ventilation - Select appropriate tube size - Prefer cuffed endotracheal tubes - Maintain cuff pressure at 20 cm of H2O	- Elevation of the head of bed in infants and children, so that upper torso remains at 30o–45o angle to the rest of body - Oral care in pediatric patients - wiping baby’s gum twice with clean gauze or brushing teeth with paste > 2-y-old child - Minimize the duration of ventilation - Avoid unplanned extubations - Prevent condensation - Closed inline suctioning
CAUTI [43]	- Avoid unnecessary catheterization - Choose catheters of appropriate size - Use sterile items/equipment - Using chlorhexidine for cleaning - Insert catheter using strict aseptic nontouch technique - Antibiotic coated catheter - there is no evidence that it decreases symptomatic CAUTI, and therefore, they should not be used - Use closed drainage system - Secure catheter appropriately to prevent movement of urethra	- Review the need for the catheter on a daily basis and remove catheter promptly when no longer necessary - Do not break the closed drainage system. If urine specimen required, take specimen aseptically via the sampling port - Empty the bag every 8 h or when 2/3 full - Use a separate disinfected jug to collect urine from each bag; bladder irrigation or washout and instillation of antiseptics or antimicrobial agents do not prevent CAUTI, and therefore, should not be used for this purpose

CAUTI Catheter-associated urinary tract infection, CDC Centres for disease control and prevention, CLABSI Central line–associated blood stream infection, VAP Ventilator-associated pneumonia