The document discusses strategies to prevent catheter-related bloodstream infections (CRBSIs). It defines CRBSI as bacteremia originating from an intravenous catheter. It describes different types of catheters and discusses following strategies as part of a bundle approach to prevent CRBSIs: hand hygiene, maximal barrier precautions during insertion, skin antisepsis, securement and dressing of catheters, patient cleansing, use of antimicrobial catheters, and guidelines for replacement and maintenance of catheters and administration sets.

1. Prevention Of Catheter Related
Blood Stream Infections
Prepared by SDU
March 2022
CRBSIs

2. OBJECTIVES
•To define CRBSI
•To discuss different types of catheters
•To discuss the bundle approach on how to prevent and
control CRBSI

3. WHAT IS CRBSI
Is defined as the presence of bacteremia
originating from an Intravenous catheters.

4. TYPES OF CATHETERS
 Central Venous catheter
 Peripheral venous catheter
 Peripheral arterial catheter
 Umbilical catheter
 Tunneled catheter
 Non –Tunneled catheter
 Porta Catheter/implanted port

5. Tunneled Central Line
Non tunneled central Line
Implanted Port
Umbilical PICC

7. Peripheral Arterial Catheter
Peripheral Venous catheter

9. STRATEGIES FOR PREVENTION OF
CATHETER- RELATED INFECTIONS
 Education, Training and Staffing
 Selection of Catheters and Sites
 Hand Hygiene and Aseptic Technique
 Patient Cleansing
 Catheter Securement Devices
 Antimicrobial/Antiseptic Impregnated Catheters and Cuffs
 Antibiotic/Antiseptic Ointments
 Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush
and Catheter Lock Prophylaxis Guidelines on the Prevention of
Intravascular Catheter - Related

10. SELECTION OF CATHETER AND SITES
A) Peripheral catheters & midline catheters
 Use upper extremity site for catheter insertion .
 Remove peripheral venous catheters if the patients develops
signs of phlebitis, infection, or a malfunctioning catheter .

11.  Avoid the use of steel needles for the administration of fluids
and medication.
 Evaluate the catheter insertion site daily by palpation through
the dressing to discern tenderness and by inspection if a
transparent dressing is in use.
SELECTION OF CATHETER AND SITES

12. B) Central venous catheter
 Use a CVC with a minimum number of ports or lumens
essential for the management of patient.
 Promptly remove the catheter that is no longer essential.
 Catheters inserted during a medical emergency to be replaced as
soon as possible within 48 hours (when adherence to aseptic
technique cannot be ensured).

13. HAND HYGIENE AND ASEPTIC TECHNIQUE
.
Hand Hygiene is the single
most effective precaution for
prevention of infection
transmission between
patients and staff

15. HAND HYGIENE AND ASEPTIC TECHNIQUE
Hand hygiene should be performed before and after
 Accessing the catheter to draw blood or administer medications
 Dressing change
 Changing IV tubing and devices
 Palpating catheter insertion site

16.  Wear clean gloves for the insertion of peripheral intravascular
catheters.
 Sterile gloves should be worn for the insertion of arterial and
central line catheters.
 Use sterile gloves before handling the new catheter when guide
wire exchanges are performed.
 Wear either clean or sterile gloves when changing the dressing on
intravascular catheters.
HAND HYGIENE AND ASEPTIC TECHNIQUE

17. MAXIMAL BARRIER PROTECTION
Use maximal sterile barrier precautions including the cap,
mask, sterile gown, sterile gloves and sterile full body drape
for the insertion of CVCs, PICC or guide wire exchange

19. SKIN PREPARATION
Use proper skin antisepsis
A) Peripheral venous catheter insertion
70% alcohol, chlorhexidine gluconate
B) CVC and Arterial catheters
 Chlorhexidine gluconate (CHG) 0.5% chlorhexidine gluconate (CHG)
(preferably 2%) in 70% Alcohol for patients > 2 months old unless there is a
documented contraindication to CHG
 Povidone iodine
 Alcohol 70%

20. SKIN PREPARATION
 Scrub back and forth with CHG with friction for 30
seconds
 Allow to air dry completely before puncturing the site
(~2 minutes). Don't wipe, fan or blot.
 NB. For groin preparation; scrub 2 minutes and allow
to dry for 2 minutes

21. CATHETER SITE DRESSING REGIMENS
 Use either sterile gauze or sterile transparent, semi-permeable
dressing to cover the catheter site.
 If the patient is diaphoretic or if the site is bleeding or oozing, use
gauze dressing until this is resolved.
 Replace catheter site dressing if the dressing becomes damp,
loosened, or visibly soiled.

22. CATHETER SITE DRESSING REGIMENS
Do not use topical antibiotic ointment or creams on insertion sites
except for dialysis catheters.
Do not submerge the catheter or catheter site in water.
The catheter and connecting device are protected with an
impermeable cover during the shower.

23. CATHETER SITE DRESSING REGIMENS
For proper dressing change
 Use aseptic technique with clean or sterile gloves
 Perform proper skin antisepsis as part of the site care procedure:
o The preferred skin antiseptic agent is > 0.5% CHG (preferably 2%)
in 70% alcohol solution.
o If there is a contraindication to alcoholic chlorhexidine solution,
povidone iodine or 70% alcohol may also be used.
o Allow any skin antiseptic agent to fully dry prior to dressing
placement.

24.  Write the date on the dressing
 If gauze dressing: changes at least every two days
NB. A gauze dressing underneath a transparent dressing is
considered a gauze dressing and changed at least every 2 days.
 If transparent semi permeable dressing, change at least every
7 days
NB. If the patient is diaphoretic or if the site is bleeding or oozing,
use a gauze dressing until this is resolved.

25.  Immediately replace dressings that are wet, soiled or dislodged

26. CATHETER SITE DRESSING REGIMENS
 Monitor the catheter site visually when changing the
dressing or by palpation through an intact dressing on a
regular basis.
 Encourage patients to report any changes in their catheter
site or any new discomfort

27. PATIENT CLEANSING
Use a 2% chlorhexidine wash for daily skin cleansing to
reduce CRBSI
For Adult and Pediatric ICUs Only; Bathe ICU
patients over 2months of age with a chlorhexidine
preparation (on daily basis according to the unit
schedule)

28. Clinical trials of daily bathing with
no-rinse, 2% CHG impregnated
washcloths Vs soap and water
bathing.
It was found that patients receiving
the CHG intervention were
significantly less likely to acquire a
primary BSI
Daily cleansing of ICU patients with
no-rinse 2% CHG impregnated
washcloth may be a simple, effective
strategy to reduce CLABSI.

29. CATHETER SECUREMENT DEVICES
 Use a suture less securement device to reduce the risk of
infection for intravascular catheters.

30. ANTIMICROBIAL/ANTISEPTIC
IMPREGNATED CATHETERS AND CUFFS
 Use a chlorhexidine/silver sulfadiazine or minocycline/
rifampin -impregnated CVC in patients whose catheter
is expected to remain in place >5 days.

31. REPLACEMENT OF CATHETERS
 Replace peripheral arterial and venous catheter ,CVC,PICC when
clinically indicated .
 Remove peripheral arterial and venous catheter ,CVC,PICC as
soon as its no longer needed
 Replace disposable/reusable transducers along with other
components of the system( including the tubings, continuous
flush device, pressure bag and flush solution) at 96 hours interval.
 Keep all components of pressure monitoring system including flush
solution as sterile
 Minimize the number of manipulations in the pressure monitoring
system

32.  Proper replacement of administration sets used for continuous
infusion
- If propofol is administrated  Change tubing every 6-12 hours or
when the vial is changed
- If blood or blood products or fat emulsions are administrated 
Change tubing every 24 hours.
- For continuous infusions other than blood, blood products or fat
emulsions NO more frequently than every 4 days, but at least every
7 days.
REPLACEMENT OF ADMINISTRATION SET

33. NEEDLELESS INTRAVASCULAR
CATHETER SYSTEM
 Change the needleless components at least as frequently as the
administration set.
 Change the needleless connectors no more frequently than every 72 hours
or according to manufacturer’s recommendations.
 Ensure that all components of the system are compatible to minimize leaks
and breaks in the system
 Use a needleless system to access IV tubing
 Use a split septum valve (Q-syte)
 Minimize contamination risk by scrubbing the access port with an
appropriate antiseptic (chlorhexidine, povidone iodine, or 70%
alcohol) and accessing the port only with sterile devices.

34. SCRUB THE ACCESS PORT OR HUB
 Catheter hubs, needles connectors, and injection ports should be
disinfected before accessing the catheter.
 Friction and a twisting motion should be used for at least 15
seconds immediately prior to each use with an appropriate antiseptic
(> 0.5% chlorhexidine (preferably 2%) in 70% alcohol solution,
povidine iodine, or 70% alcohol). Alcoholic chlorhexidine may have
additional residual activity compared with alcohol for this purpose.
 Let the antiseptic to air dry.