The Great Reset After the Pandemic: Renewed Efforts at CLABSI Prevention Part of Addressing Escalating HAI Rates
By Kelly M. Pyrek
Recently updated guidance from five medical organizations highlights practice recommendations for the prevention of central line-associated bloodstream infections (CLABSIs) at a time when hospitals urgently need to strengthen infection prevention programs. The CLABSI prevention guide is the first to be published in a series of seven evidence-based practice recommendation guides for acute-care hospitals on the prevention of healthcare-associated infections (HAIs).
The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates was issued under the leadership of the Society for Healthcare Epidemiology of America (SHEA) in partnership with 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, with representatives from the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Diseases Society (PIDS), and other organizations with content expertise. The Compendium: 2022 Update is the third iteration of the Compendium, which was originally published in 2008 and revised in 2014.
When it comes to guidance development, specifically for purposes of the Compendium, Kelly Cawcutt, MD, director of medical quality for Nebraska Medicine, explains, “Panels of experts are brought together who understand the intricacies of the clinical infection control and regulatory components of the guideline subject matter. These experts are engaged in and understand the science of the research at hand. For the updates to the Compendium, a substantial search is performed on all the published scientific medical literature upon which we rely for evidence-based care. They are then reviewed for the quality of evidence. Specifically, for the CLABSI update, experts examined data on how central line-associated bloodstream infections are prevented. The way that the evidence is usually reviewed is that multiple people are looking at this long list of references, looking for what might need to be included, but then also examining the level of evidence. When we discuss the level of evidence, we're talking about premier-level evidence provided through randomized controlled trials, particularly those that are blinded. They also look at the systematic reviews and meta-analyses that include randomized controlled trials to get the highest level of data to help us to drive those recommendations. That is what shifts the needle on guidelines.”
Cawcutt continues, “When you talk about unresolved issues, one of the things that beautiful about this update is that every person who's interested in CLABSI is going to read this Compendium at some point, and they're going to discern where there are gaps in the evidence. That helps researchers and healthcare professionals in the realm of infection control understand the areas in which more research is needed to help decide how to resolve these gaps for the next update of the Compendium.”
Let’s review the major revisions for 2022.
The updated Compendium emphasizes the subclavian vein as the preferred site for central venous catheter (CVC) insertion in the intensive care setting to reduce infectious complications. Previously, the primary recommendation was to avoid the femoral vein for access. Although this remains valid, it has been replaced by a positively formulated recommendation regarding the subclavian site.
Read further from the September 2022 issue HERE