New expert 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 from a series of seven concise, evidence-based practice recommendation guides for acute care hospitals on the prevention of healthcare-associated infections that threaten patient safety.
The Compendium, as this series has been known since its first publication in 2008, is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world. The 2022 update will also include guidance for improving hand hygiene practices in hospitals, and a document on concepts and frameworks to successfully implement healthcare-associated infection prevention practices. The authors note that the Compendium documents may help hospitals restart conversations about quality indicators and remind hospitals to reinforce healthcare-associated infections preventive measures outside of COVID-19.
“Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years, the rates of CLABSIs and several other healthcare-associated infections have substantially worsened during the COVID-19 pandemic, reversing years of progressive improvement,” said Dr. Deborah Yokoe, Society for Healthcare Epidemiology of America (SHEA) chair of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates. “These infections seriously threaten patients’ lives and recovery and the rising rates are further evidence for the need to build more resilient systems of care. The Compendium is foundational for helping hospitals do this.”
Each Compendium article provides concise lists and rationale for practical evidence- and consensus-based “essential practices,” which all acute care hospitals should implement, and “additional approaches,” which hospitals should consider when infections are not controlled by full implementation of essential practices. Some highlights from the updated CLABSI guidance include:
The subclavian vein is now considered the preferable site for central venous catheter (CVC) insertion in intensive care patients to reduce infectious complications.
Chlorhexidine-containing dressings are now considered an “essential practice” in patients over two months of age.
Examples of “additional approaches" to be used by hospitals when CLABSIs are not controlled after implementation of essential practices, include the use of antiseptic- or antimicrobial-impregnated CVCs and the use of antiseptic-containing hub/connector cap/port protectors to cover connectors.
The document also reviews interventions that are not recommended and those that remain unresolved due to inadequate evidence.
Infection Control and Hospital Epidemiology published the Compendium under the leadership of the Society for Healthcare Epidemiology of America (SHEA). Partnering organization include the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with representatives from the Centers for Disease Control and Prevention, the Pediatric Infectious Diseases Society, 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.
The full suite of Compendium articles scheduled to publish throughout 2022 will include strategies to prevent catheter-associated urinary tract infections, Clostridium difficile infections, methicillin-resistant Staphylococcus aureus infections, surgical site infections, ventilator-associated- pneumonia and -events, and non-ventilator healthcare-associated-pneumonia. Hand hygiene also has a dedicated article. Each Compendium article contains infection prevention strategies, performance measures, and example implementation approaches. Compendium recommendations are derived from a synthesis of systematic literature review and evaluation of the evidence, practical and implementation-based considerations, and expert consensus.
"Preventing healthcare-associated infections is a national and global priority," says Sharon B. Wright, MD, MPH, FIDSA, FSHEA, president of the SHEA board of trustees. "It’s a pivotal time. We must get back to basics, redouble efforts, and create systems of care that even in situations of great stress have what they need to keep patients safe from preventable healthcare-associated infections.”