Central line-associated bloodstream infection (CLABSI) is one of the most serious and costly healthcare-associated infections — with mortality rates of 12–25% and average attributable costs exceeding $45,000 per episode.[1][2] Evidence shows that implementing a structured 5-element insertion bundle reduces CLABSI rates by up to 66%.[1][3] This bundle is the standard of care for all Georgian facilities managing central venous catheters.
Insertion bundle — all 5 elements are mandatory, every insertion
| # | Bundle element | Standard |
|---|---|---|
| 1 | Hand hygiene | Surgical hand scrub or ABHR rub before donning sterile gloves; performed immediately before the procedure |
| 2 | Maximal barrier precautions | Operator: sterile gloves + sterile gown + surgical mask + cap; Patient: large sterile drape covering entire body except insertion site |
| 3 | Chlorhexidine skin antisepsis | 2% chlorhexidine gluconate in 70% isopropyl alcohol; apply with back-and-forth scrubbing for 30 seconds; allow to air dry completely (≥30 seconds) before insertion. Alternative: 10% povidone-iodine if chlorhexidine contraindicated (allergy, age <2 months) |
| 4 | Optimal catheter site selection | Subclavian vein preferred for non-tunnelled lines (lowest CLABSI risk)[2]; femoral vein avoided unless no alternative (highest infection and DVT risk); internal jugular acceptable; document site selection rationale |
| 5 | Daily review of line necessity — remove promptly | Written checklist reviewed by physician daily: does this patient still need this central line? Remove as soon as no longer clinically indicated. Lines not reviewed daily are a protocol violation. |
Maintenance bundle — daily care of every central line
| Element | Standard | Frequency |
|---|---|---|
| Dressing management | Transparent semi-permeable dressing (TSM) changed every 7 days and when wet, loose or soiled; gauze dressing changed every 2 days; sterile technique for all dressing changes; chlorhexidine-impregnated patch at exit site recommended for high-risk patients | Per schedule or when indicated |
| Needleless connector care | Disinfect connector with 70% alcohol or chlorhexidine swab before each access; scrub for minimum 15 seconds and allow to dry; change connector every 96 hours or when removed for any reason | Before each access |
| Administration set changes | Standard IV sets: every 96 hours; lipid-containing solutions: every 24 hours; blood and blood products: within 4 hours of initiating each unit; propofol: per manufacturer guidance | Per schedule |
| Exit site inspection | Inspect at every dressing change for erythema, induration, purulence, tenderness; document findings; if infection suspected — notify physician immediately, consider line removal | Every dressing change + daily visual check |
| Line necessity review | Document daily: clinical indication still present? Potential to convert to peripheral or oral therapy? Goal: line days minimised | Daily |
CLABSI surveillance case definition (NHSN/WHO)
CLABSI = laboratory-confirmed bloodstream infection (LCBI) in a patient who had a central line in place for >2 calendar days on the date of the event AND the central line was in place on the date of the event or the day before, AND the BSI is not secondary to an infection at another body site. Laboratory criteria: recognised pathogen cultured from ≥1 blood culture[6]; OR common commensal (coagulase-negative Staph, Bacillus spp., Corynebacterium spp., Propionibacterium, viridans streptococci, Aerococcus, Micrococcus) from ≥2 blood cultures drawn on separate occasions AND at least one of: fever >38°C, chills, or hypotension. CLABSI rate = CLABSI events ÷ central line-days × 1,000.
In plain language
The CLABSI bundle is a small set of evidence-based steps that, done together every time, prevent bloodstream infections from central venous catheters: at insertion and throughout maintenance.
Why it matters
Key actions checklist
- Hand hygiene before insertion and every access
- Maximal sterile barrier precautions at insertion
- Chlorhexidine-based skin antisepsis
- Optimal site selection, avoiding the femoral vein in adults where possible
- Daily review of line necessity and prompt removal
International guidance
- WHO Guidelines on core components of IPC programmes (2016)
- WHO Global report on infection prevention and control (2022)
Questions and answers
Why a bundle rather than single measures?
The effect comes from applying all elements together, reliably, and auditing compliance.
How is success measured?
CLABSI rate per 1,000 catheter-days and bundle compliance.
Related pages
Georgian IPC National Guideline and NCDC HAI Surveillance — NCDC Georgia
Open Georgian source →Additional reference →NCDC Georgia HAI surveillance protocols (Georgian). CDC NHSN CLABSI surveillance definition (English) — the international standard used in Georgia.
References
- [1] Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–2732. doi:10.1056/NEJMoa061115
- [2] O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162–e193. doi:10.1093/cid/cir257
- [3] Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Central Line-Associated Bloodstream Infections. IHI. 2012;—:—. Available at: https://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCentralLineAssociatedBloodstreamInfection.aspx
- [4] WHO. Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. World Health Organization. 2016;—:—. Available at: https://www.who.int/publications/i/item/9789241549929
- [5] Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update. Clin Infect Dis. 2009;49(1):1–45. doi:10.1086/599376
- [6] CDC/NHSN. NHSN Patient Safety Component Manual: Central Line-Associated Bloodstream Infection (CLABSI) Event. Centers for Disease Control and Prevention. 2024;—:—. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
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