Healthcare Infection Control Practices Advisory Committee (HICPAC) recommendations for the prevention of intravenous device related bloodstream infections (IVDR BSI).*
| * Adapted from the draft of the Healthcare Infection Control Practices Advisory Committee (HICPAC) guideline for the prevention of intravascular catheter-related infections.10 |
| General Measures |
| Education of all healthcare workers involved with vascular access regarding indications for use, proper insertion technique and maintenance of IVDs |
| Surveillance: |
| Institutional rates of IVDR BSI monitored routinely |
| Rates of central venous catheter (CVC)-related BSI using standardized definitions and denominators, expressed per 1000 CVC-days |
| At Insertion |
| Aseptic technique: |
| Hand washing before inserting or manipulation of any IVD |
| Clean or sterile gloves during insertion or manipulation of non-central IVD |
| Maximal barrier precautions (mask, cap, long-sleeved sterile gown, sterile gloves, and sterile sheet-drape) during insertion of CVCs |
| Dedicated IV teams strongly recommended |
| Cutaneous antisepsis: chlorhexidine preferred, however, an iodophor, such as 10% povidone-iodine, tincture of iodine or 70% |
| Sterile gauze or a sterile semipermeable polyurethane film dressing |
| Systemic antibiotics at insertion strongly discouraged |
| Maintenance |
| Remove IVDs as soon as their use is no longer essential |
| Monitor the IVD site on regular basis, ideally daily |
| Change dressing of CVC insertion site at least weekly |
| Topical antibiotic ointmentsnot recommended |
| Systemic anticoagulation with low-dose warfarin (1 mg daily) for patients with long-term IVDs and no contraindication. |
| Replace PIVCs every 72 hours |
| Replace administration sets every 72 hours unless lipid-containing admixture or blood products given, then every 24 hours |
| Technology |
| Consider use of chlorhexidine-impregnated sponge dressing with adolescent and adult patients with non-cuffed central venousor arterial catheters expected to remain in place for 4 days or more. |
| If after consistent application of basic infection control precautions, the institutional rate of IVDR BSI is yet high with short-term CVCs(≥ 3.3 BSIs per 1000 IVD-days), consider the use of an anti-infective coated CVC (chlorhexidine-silver sulfadiazine or minocycline-rifampin). |
| In individual patients with long-term IVDs who have had recurrent IVDR BSIs despite consistent application of infection control practices, consider the use of a prophylactic antibiotic lock solution (i.e., heparin with vancomycin (25 μg/mL), with or without, ciprofloxacin (2 μg/mL). |
| * Adapted from the draft of the Healthcare Infection Control Practices Advisory Committee (HICPAC) guideline for the prevention of intravascular catheter-related infections.10 |
| General Measures |
| Education of all healthcare workers involved with vascular access regarding indications for use, proper insertion technique and maintenance of IVDs |
| Surveillance: |
| Institutional rates of IVDR BSI monitored routinely |
| Rates of central venous catheter (CVC)-related BSI using standardized definitions and denominators, expressed per 1000 CVC-days |
| At Insertion |
| Aseptic technique: |
| Hand washing before inserting or manipulation of any IVD |
| Clean or sterile gloves during insertion or manipulation of non-central IVD |
| Maximal barrier precautions (mask, cap, long-sleeved sterile gown, sterile gloves, and sterile sheet-drape) during insertion of CVCs |
| Dedicated IV teams strongly recommended |
| Cutaneous antisepsis: chlorhexidine preferred, however, an iodophor, such as 10% povidone-iodine, tincture of iodine or 70% |
| Sterile gauze or a sterile semipermeable polyurethane film dressing |
| Systemic antibiotics at insertion strongly discouraged |
| Maintenance |
| Remove IVDs as soon as their use is no longer essential |
| Monitor the IVD site on regular basis, ideally daily |
| Change dressing of CVC insertion site at least weekly |
| Topical antibiotic ointmentsnot recommended |
| Systemic anticoagulation with low-dose warfarin (1 mg daily) for patients with long-term IVDs and no contraindication. |
| Replace PIVCs every 72 hours |
| Replace administration sets every 72 hours unless lipid-containing admixture or blood products given, then every 24 hours |
| Technology |
| Consider use of chlorhexidine-impregnated sponge dressing with adolescent and adult patients with non-cuffed central venousor arterial catheters expected to remain in place for 4 days or more. |
| If after consistent application of basic infection control precautions, the institutional rate of IVDR BSI is yet high with short-term CVCs(≥ 3.3 BSIs per 1000 IVD-days), consider the use of an anti-infective coated CVC (chlorhexidine-silver sulfadiazine or minocycline-rifampin). |
| In individual patients with long-term IVDs who have had recurrent IVDR BSIs despite consistent application of infection control practices, consider the use of a prophylactic antibiotic lock solution (i.e., heparin with vancomycin (25 μg/mL), with or without, ciprofloxacin (2 μg/mL). |