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Guideline Update: How to Best Prevent Central Line-Associated Bloodstream Infections

Dr. Mark Rupp, MD

Professor, Department of Internal Medicine
Chief, Division of Infectious Diseases
Medical Director, Infection Control & Epidemiology
Associate Medical Director, Antimicrobial Stewardship 

Dr. Rupp recently assisted in the creation of new clinical guidelines aimed at prevention of central line-associated bloodstream infections.

What are clinical guidelines and why are they important?

Clinical guidelines are a crucial component of evidence-based medicine. They are issued to standardize medical care across the nation and are often determined using an extensive literature review process with input from panels of experts in the field. These guidelines were updated with input from the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, as well as representation by the Centers for Disease Control and Prevention (CDC).

Why do guidelines need to be updated?

Best medical practices are often a moving target, especially in infectious disease. Pathogens change over time, as does medical technology and the scientific literature describing clinical problems. Guideline updates are one of the most straightforward ways that research can update clinical practice to ensure we are always acting in the best interest of patients.

What are the major changes in this guideline update?

There are 4 major changes with this 2022 update:

  • The subclavian vein is recommended for central venous catheter (CVC) insertion in the intensive care setting. Previous recommendations advised avoiding femoral vein for access, which remains valid.
  • Ultrasound guidance for catheter insertion is bolstered by greater evidence and now is more strongly recommended, although strict attention to sterile technique is advised.
  • The use of chlorhexidine-containing dressings is now considered an “essential practice”; previously, this was recommended only during periods of high infectious risk.
  • Routine replacement of administration sets not used for blood, blood products, or lipid formulations can be performed at intervals of up to 7 days, instead of the previous recommended interval of no longer than 4 days.

Are there any other changes?

Yes! There are several other guideline changes outlined in the updated guidelines. For details, guideline creation methods, and additional changes, see the full guideline document here.

Thanks to Dr. Rupp for his contribution to this vital process to evidence-based medicine!

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