1. Presentation adapted from APIC 2014 Convention “3024: High Risk Central Lines: What Else Can We Do?”

2.  Multiple catheters and/or multiple lumens  Emergency insertion  Prolonged duration of CVC  Prolonged hospital stay prior to CVC insertion  Excessive manipulation of the catheter  Neutropenia  Prematurity  Total parenteral nutrition  Source: CDPH “CLABSI Prevention” presentation

3. Insertion Bundle Maintenance Bundle  Full body drape  Hand hygiene  Max barrier: sterile gown, gloves, mask and cap  CHG prep, SCRUB  CHG sponge at site  Monitor compliance to bundle  Needleless adaptor on all lumens  Anyone can call “STOP”  Daily assessment of continued need  Hand Hygiene  Scrub the hub – 15 sec (LET IT DRY!)  Clean, intact, occlusive dressing  Change tubing per policy  Evaluate lumen patency  Minimize access -> group activities  Flush per policy

4.  After implementation of CLABSI bundles (insertion and maintenance): Who was still getting infections? ◦ Non- ICU patients ◦ Long term lines ◦ Oncology patients ◦ Varied insertion sites ◦ Short-gut kids

8.  Daily baths with chlorohexidine wipes (start at central line site and work out, then chin to toes)  Daily linen changes  All central line tubing is to be secured in upward direction to prevent touching of things such as surgical wounds, ostomies, diarrhea (i.e. added infection risk sources)

9.  Protect femoral line from diarrhea. Dress line in specific manner to help prevent IV tubing and line from coming in contact with diarrhea (i.e. larger dressings, skin protectants, etc…)  If central line dressing requires reinforcing, dressing needs to be changed  Discuss with MD the implementation of ethanol lock or antibiotic lock (depending on central line catheter material – ethanol not compatible with polyurethane, ok with silicone. Contact IVT for help/intervention).