Prevention of Central Line–Associated Bloodstream Infections

This NEJM review evaluates the prevention of central line–associated bloodstream infections (CLABSIs), which occur from central venous catheter use across medical settings. CLABSI significantly increases hospital stay, costs, and mortality. High-quality evidence supports multiple prevention strategies, including: insertion checklists, catheter-insertion kits, hand hygiene, maximal sterile barrier precautions, alcoholic chlorhexidine antisepsis, subclavian site preference, chlorhexidine dressings and bathing, antimicrobial-impregnated catheters, and antiseptic-containing hubs and caps. Risk factors include patient factors (immunocompromise, prolonged hospitalization), provider practices (emergency insertion, poor technique), and device factors (site, lumens). CLABSI rates dropped significantly in the early 2000s due to these interventions, but rose during COVID-19 due to strained resources and disrupted infection control.

This NEJM review evaluates the prevention of central line–associated bloodstream infections (CLABSIs), which occur from central venous catheter use across medical settings. CLABSI significantly increases hospital stay, costs, and mortality. High-quality evidence supports multiple prevention strategies, including: insertion checklists, catheter-insertion kits, hand hygiene, maximal sterile barrier precautions, alcoholic chlorhexidine antisepsis, subclavian site preference, chlorhexidine dressings and bathing, antimicrobial-impregnated catheters, and antiseptic-containing hubs and caps. Risk factors include patient factors (immunocompromise, prolonged hospitalization), provider practices (emergency insertion, poor technique), and device factors (site, lumens). CLABSI rates dropped significantly in the early 2000s due to these interventions, but rose during COVID-19 due to strained resources and disrupted infection control.