Table 3 Guidelines for prevention of intravascular catheter associated infections

Education and training:

 Educate health care personnel regarding indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters and appropriate infection control measures

 Periodically reassess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of intravascular catheters

 Designate only trained personnel who demonstrate competence for the insertion and maintenance of central intravascular catheters.

Catheter placement and duration of use

 Weigh the risks and benefits of placing a central venous catheter.

 Evaluate daily if catheter is still necessary

 Promptly remove any intravascular catheter that is no longer essential

 Remove and do not replace umbilical artery catheters if any signs of catheter-related bloodstream infection, vascular insufficiency in the lower extremities or thrombosis are present. Optimally umbilical catheters should not be left in place > 5 days.

 Remove and do not replace umbilical venous catheters if any signs of CLABSI or thrombosis are present. Umbilical venous catheters should be removed as soon as possible but can be used up to 14 days if managed aseptically.

Placing catheters

 Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, or dressing an intravascular catheter.

 Maintain aseptic technique for insertion and care of intravascular catheters.

 Maximum sterile barrier precautions including the use of a cap, mask, sterile gown, sterile gloves and a sterile large drape are necessary for the insertion of a central venous catheter.

 A minimum of a cap, mask, sterile gloves and a small sterile fenestrated drape should be used during peripheral arterial catheter insertion.

 Prepare insertion site with povidone iodine/chlorhexidine containing antiseptic (no recommendation can be made about the safety of chlorhexidine in infants < 2 months)

 Use sterile gauze or sterile, transparent semi-permiable dressing to cover catheter site.

 Do not use topical antibiotic ointment or creams on insertion sites because of potential to promote fungal infections and antimicrobial resistance.

 Do not administer systemic antimicrobial prophylaxis routinely before insertion or during use of an intravascular catheter to prevent catheter colonization or CLABSI.

Dressing catheters

 Use sterile gloves when changing the dressing

 Replace catheter site dressing if the dressing becomes damp, loose or visibly soiled.

Catheter care

 Use the minimum number of ports or lumens essential for management of the patient

 Do not submerge the catheter or catheter site in water.

 Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices.

 Replace tubing used to administer blood, blood products, or fat emulsions (those combined with amino acids and glucose or infused separately) within 24 h of initiating the infusion.