NICU: CLABSI Guidelines

Recommendations for Prevention and Control of Infections in Neonatal Intensive Care Unit Patients: Central Line-associated Blood Stream Infections

Summary of Recommendations

1.

The use of non-sterile gloves after hand hygiene, but before all patient contact, compared with hand hygiene alone, to reduce central line-associated bloodstream infection (CLABSI) in neonatal intensive care unit (NICU) patients, remains an unresolved issue.

Recommendation 1. details.

No Recommendation

2.a.

Choose the central line type (e.g., umbilical venous catheter (UVC), peripherally inserted central catheter (PICC), tunneled catheter, etc.) based on the clinical needs of the neonatal intensive care unit (NICU) patient.

Recommendation 2.a. details.

Recommendation

2.b.

The choice of central line type to insert in a neonatal intensive care unit (NICU) patient should not be based solely on central line-associated blood stream infection (CLABSI) prevention.

Recommendation 2.b. details.

Recommendation

3.a.

Choose the insertion site appropriate to the central line type to be inserted in a neonatal intensive care unit (NICU) patient (e.g., UVC, PICC, etc.) based on the clinical needs of the patient.

Recommendation 3.a. details.

Recommendation

3.b.

The choice of insertion site in a neonatal intensive care unit (NICU) patient should not be based solely on central line associated blood stream infection (CLABSI) prevention.

Recommendation 3.b. details.

Recommendation

4.

Consider choosing the fewest number of lumens based on the clinical needs of the neonatal intensive care unit patient.

Recommendation 4. details.

Conditional recommendation

5.

Consider the use of alcohol-containing chlorhexidine for skin antisepsis to prevent central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients in whom the benefits are judged to outweigh the potential risks. Gestational age, chronologic age, and skin maturity should be considered when assessing risks and benefits of chlorhexidine-containing agents in determining eligible patients.

Recommendation 5. details.

Conditional recommendation

6.a.

Consider use of chlorhexidine bathing to prevent central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients in whom the benefits are judged to outweigh the potential risks.

Recommendation 6.a. details.

Conditional recommendation

6.b.

The identification of neonatal intensive care unit (NICU) patients who might benefit from chlorhexidine bathing remains an unresolved issue.

Recommendation 6.b. details.

No recommendation

6.c.

If undertaken, the frequency of chlorhexidine bathing for neonatal intensive care unit (NICU) patients remains an unresolved issue.

Recommendation 6.c. details.

No recommendation

7.

Minimize the number of times central line hubs are accessed and minimize blood sampling through central lines to decrease the risk for central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients.

Recommendation 7. details.

Recommendation

8.

Consider central line antimicrobial locks for neonatal intensive care unit (NICU) patients in addition to core infection prevention and control strategies when a unit is experiencing ongoing central line-associated blood stream infection (CLABSIs).

Recommendation 8. details.

Conditional Recommendation

9.a.

Remove umbilical venous and umbilical arterial catheters in neonatal intensive care unit (NICU) patients as soon as possible and when no longer needed due to the concern for increasing risk of central line-associated blood stream infection (CLABSI) associated with each day of increasing dwell time.

Recommendation 9.a. details.

Recommendation

9.b.

Consider removal of umbilical artery catheters at or before 7 days of dwell time in neonatal intensive care unit (NICU) patients.

Recommendation 9.b. details.

Conditional Recommendation

9.c.

Consider removal of umbilical venous catheters at or before 7 days of dwell time in neonatal intensive care unit (NICU) patients.

Recommendation 9.c. details.

Conditional Recommendation

9.d.

Consider removal of umbilical venous catheters and inserting a peripherally inserted central catheter (PICC) or other long-term central venous catheter at or before 7 days of umbilical venous catheter dwell time for neonatal intensive care unit (NICU) patients requiring long-term central venous access.

Recommendation 9.d. details.

Conditional Recommendation

10.a.

For neonatal intensive care unit (NICU) patients, remove peripherally inserted central catheters (PICCs) as soon as possible and when no longer needed due to the concern for increasing risk of central line-associated blood stream infection (CLABSI) associated with increasing dwell time.

Recommendation 10.a. details.

Recommendation

10.b.

For neonates with ongoing need for central venous access, whether to remove and replace a peripherally inserted central catheter (PICC) that has been in place for a prolonged period of time to reduce central line-associated blood stream infection (CLABSIs) in neonatal intensive care unit (NICU) patients remains an unresolved issue.

Recommendation 10.b. details.

No Recommendation

11.

Consider implementing a dedicated catheter care team to prevent central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients.

Recommendation 11. details.

Conditional Recommendation

12.

Use “bundled” interventions for central line insertion and maintenance as part of a single or multiple intervention quality improvement effort to reduce rates of central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients. Elements of insertion and maintenance bundles for all patients have been recommended by the Centers for Disease Control and Prevention.

Recommendation 12. details.

Recommendation

13.

Do not use prophylactic antimicrobial infusions routinely to decrease the risk of bacterial central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients.

Recommendation 13. details.

Recommendation

14.

Do not use prophylactic anticoagulant infusions for the purposes of preventing central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients.

Recommendation 14. details.

Recommendation