High Risk Patients
Element
Key Institutional Partners
  • Dressing audits should be performed to examine whether site is clean, dry, intact and the catheter is appropriately secured
    • Movement of the catheter at the exit site (“pistoning”) can induce endothelial injury and promote phlebitis which can cause thrombosis
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
Articles/References
​Articles:
Herc E, et al.  Model to Predict Central-Line-Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score. Infection Control & Hospital Epidemiology 2017
  • Risk factors for CLABSI in patients with PICC lines include:  hematological cancer, history of CLABSI within 3 months of PICC insertion, multi-lumen PICCs, solid cancers with ongoing chemotherapy, receipt of total parenteral nutrition through the PICC, and the presence of another central venous catheter (CVC)
National Resources:
Validation Survey
CLABSI Step 3 Validation - Advanced Approaches/Targeted Solutions.
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress.
Consider Antimicrobial Dressings
Element
Key Institutional Partners
  • Chlorhexidine Gluconate (CHG)-impregnated sponge dressings (e.g., BioPatch)
Provider, IR, Vascular Team, Hospital Leadership/Nursing Leadership
Resources/Tools​​​
Articles/References
​National References:Articles:
Page J, et al. Reducing oncology unit central line-associated bloodstream infections:  Initial results of a simulation-based educational intervention. Journal of Oncology Practice 2016
  • A targeted educational intervention for central-line care on an Oncology unit proved to decrease CLABSIs and increase competence in care of central-lines. A simulated central-line care model was used for the purpose of this testing
Consider Chlorhexidine Gluconate (CHG)--bathing in high risk patients
Element
Key Institutional Partners
  • Chlorhexidine Gluconate (CHG) bathing protocols are appropriate for patients that are high-risk for developing CLABSI
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
Resources/Tools​​​
Articles/References
​Reeber C, et al. Chlorhexidine bathing to reduce CLABSI in hematopoetic stem cell transplant in hematologic malignancy patients. Journal of Clinical Oncology 2012
  • Chlorhexidine is an effective, minimally invasive intervention in preventing CLABSI on Oncology units, however unexpected barriers appeared as many caregivers and patients underestimate the importance of daily bathing as a key clinical intervention
Consider antimicrobial catheters in patients at high risk of CLABSI
Element
Key Institutional Partners
  • Minocycline-RMP coated PICCs
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
  • ​Chlorhexidine Gluconate (CHG)-impregnated PICCs
​Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
Resources/Tools​​​
Articles/References
​Kramer R, et al. Are Antimicrobial Peripherally Inserted Central Catheters Associated with Reduction in Central Line–associated Bloodstream Infection? A Systematic Review and Meta-analysis. American Journal of Infection Control 2017
  • Antimicrobial PICCs may reduce CLABSI, especially in high-risk subgroups
Ullman AJ, et al. Do antimicrobial and antithrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications? An analysis of 42,562 hospitalized medical patients. Infect Control Hosp Epidemiol. 2021;1-8. doi:10.1017/ice.2021.141
  • A study of 52 hospitals found that antimicrobial and antithrombogenic PICCs were not associated with a reduction in major catheter complications. Guidance aimed at informing use of these devices, balancing benefits against cost, appear necessary.