CVC infection prevention: CDC guidelines

Prevention of central venous catheter (CVC) infections has become an important patient safety and quality improvement measure over the last decade. In 2011, the CDC amended their guidelines to provide the most up to date, evidence-based practice recommendations for preventing catheter related infections. Each recommendation is categorized based on existing scientific data, theoretical rationale, applicability and economic impact. Category IA is strongly recommended and supported by much evidence, Category IB is strongly recommended and supported by some evidence, Category IC is required by state or federal regulations and Category II is suggested for implementation.

Below are the key elements of the CDC guidelines with the Category ranking in parentheses alongside the recommendation:

1. Education
   • Educate personnel regarding the indications, proper procedures and maintenance of intravascular catheters (IA)
   • Periodically assess knowledge of and adherence to guidelines (IA)
   • Designate only trained personnel who demonstrate competence for the insertion and maintenance of CVLs (IA)
2. Site selection for CVL
   • Avoid the femoral vein (IA)
   • Use the subclavian vein whenever possible and safe (IB)
   • Use a non-subclavian vein in HD patients or patients with advanced kidney disease to avoid subclavian stenosis (IA)
   • Use a fistula or graft rather than a CVL if available for dialysis (IA)
   • Use ultrasound guidance to reduce cannulation attempts (IB)
   • Use a CVL with the minimum number of access ports (IB)
   • Remove any catheter that is not essential (IA)
   • When adherence to aseptic technique cannot be ensured, replace the line ASAP (IB)
3. Hand hygiene
   • Wash your hands with conventional soap or alcohol based hand rubs before palpating insertion sites or inserting, accessing, repairing or dressing a catheter. Palpation of insertion site should not be performed after application of a dressing (IB)
   • Use sterile gloves for central, arterial and midline catheters (IA)
   • Use clean or sterile gloves when changing a CVL dressing (IC)
4. Skin prep
   • Prepare skin with >0.5% chlorhexidine with alcohol before CVL insertion and dressing changes (IA)
5. Barrier precautions
   • Wear a cap, mask, sterile gown and gloves and use a full body drape (IB)
6. Dressing
   • Use either sterile gauze or sterile transparent semipermeable dressings (IA)
   • Change gauze dressings every 2 days (II)
   • Change transparent dressings every 7 days (IB)
   • Use a chlorhexidine impregnated sponge dressing in patients > 2months old if CLABSI rate is not decreasing despite adherence to basic prevention measures (IB)
   • Monitor the catheter sites visually when changing the dressing or by palpation through an intact dressing on a regular basis (IB)
7. Replacement of CVLs
   • Do not routinely replace CVCs to prevent infections (IB)
   • Do not use guide wire exchanges in lines suspected of infection (IB)
   • Use a guide wire exchange to replace a malfunctioning non-tunneled catheter if no evidence of infection is present (IB)