Poor adherence to CLABSI prevention guidelines worldwide

Cristina Valencia, Naïma Hammami et el published a worldwide survey of healthcare professionals in this month’s Antimicrobial Resistance & Infection Control journal.
Overall, only 23% of the ICUs strictly adhere to the guidelines to prevent CLABSI.

Just for review, here are the components of CLABSI prevention bundle by the Joint Commission

  1.  Hand hygiene
    Hands are decontaminated immediately before and after each episode of patient contact using the correct hand hygiene technique. An organized approach such as that of the World Health Organization (WHO) “5 Moments of Hand Hygiene” or the British National Patient Safety Association (NPSA) “Clean Your Hands” campaign may be used.
  2. Use of full barrier precautions/personal protective equipment
    Maximal sterile barriers and aseptic technique, including a sterile gown, sterile gloves, and a large sterile drape, are used for the insertion of a central venous access device.
    Full facial protection is worn if there is a risk of splashed blood or other bodily fluids.
  3. Chlorhexidine skin antisepsis
    A solution of 2% chlorhexidine gluconate in 70% isopropyl alcohol is used and allowed to dry for at least 30 seconds. If a patient is sensitive to this agent, a single patient use povidone-iodine application may be used.
    Aseptic technique is maintained throughout insertion of CVCs. Antisepsis for infants is consistent with local policy or current science for neonates.
  4. Optimal catheter type selection
    A catheter with the minimum number of ports or lumens necessary for that patient should be selected.
  5. Aseptic lumen access
    Antimicrobial-impregnated catheter is used if the duration is estimated to be for an extended period of time and the risk of CLABSI high.
  6. Optimal catheter site selection
    Selection of a central line placement site should be guided by such considerations as patient comfort, patient-specific factors (such as preexisting catheters, irregularities in hemostasis, or anatomic anomalies), risk of complications (such as bleeding risk or pneumothorax), infection risk, potential for ambulation, and operator experience. An assessment of the risk/benefit analysis in each specific clinical situation also should contribute to the final decision regarding CVC placement. Adult Patients: Avoid the femoral vein for inserting CVCs (except in children); catheter is inserted into the subclavian or internal jugular unless a PICC line is used. Pediatric Patients: Optimal catheter type and site selection in children is more complex, with the internal jugular vein or femoral vein most commonly used.
  7. Dressing
    A sterile dressing is applied (gauze, transparent dressing, gauze and transparent dressing, antimicrobial foam disc).
  8. Safe disposal of sharps
    Sharps are disposed of safely at the point of care and in accordance with local policy.
  9. Daily review of line necessity, with prompt removal of unnecessary CVCs

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