Executive Summary

Recommendations for the Prevention and Control of Central Line-associated Blood Stream Infections in Neonatal Intensive Care Unit Patients provide new, evidence-based recommendations specific to the prevention and control of Central Line-associated Blood Stream Infections (CLABSI) in neonatal intensive care unit (NICU) patients. This document is one section of the full Guideline for Infection Prevention and Control in Neonatal Intensive Care Unit Patients. This guideline will be published in a segmental manner as sections are completed. This section does not provide a comprehensive set of infection control recommendations for the prevention of CLABSI in NICU patients. Core infection prevention and control recommendations for the prevention of CLABSI that apply across all healthcare settings are summarized in the Healthcare Infection Control Practices Advisory Committee (HICPAC) Core Practices document,[1] and the original recommendations can be found in the respective Centers for Disease Control and Prevention (CDC) and HICPAC Guidelines.[2]

The recommendations were based on a systematic review of the best available evidence in the literature from the beginning date of each database through February 2017. Subject matter experts supplemented the literature search results by recommending relevant references published since February 2017. In order to provide explicit links between the evidence and recommendations, a GRADE approach was used to evaluate the strength and direction of the evidence and formulate recommendations. The Methods section of this guideline provides additional detail on the development of this document. Where evidence was insufficient to formulate evidence-based recommendations in this effort, interim guidance is available to inform the delivery of healthcare in NICUs. [SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches for the prevention of central line-associated bloodstream infectionsexternal icon].

The evidence review was guided by the following questions:

1. Does the use of non-sterile gloves after hand hygiene, compared with hand hygiene alone, prevent CLABSI in NICU Patients?
2. Does the use of one central line catheter type, compared with another, prevent CLABSI in NICU patients?
3. Does the use of one central line catheter insertion site, compared with another, prevent CLABSI in NICU patients?
4. Does the use of single-lumen, compared with double-lumen, umbilical venous catheters prevent CLABSI in NICU patients?
5. In NICU patients requiring skin antisepsis for catheter insertion and maintenance, does alcoholic chlorhexidine, compared with alcoholic povidone-iodine, prevent CLABSI?
6. Does chlorhexidine bathing, compared with no bathing or bathing with placebo, prevent CLABSI in NICU patients?
7. In NICU patients with central line catheters, does minimizing the number of times central line hubs are accessed prevent CLABSI?
8. In NICU patients with central line catheters, does the use of central line antimicrobial locks, compared with standard of care, prevent CLABSI?
9. What is the optimal duration of umbilical artery and umbilical venous catheters to prevent CLABSI in NICU patients?
10. What is the optimal duration for peripherally inserted central catheters to prevent CLABSI in NICU patients?
11. Does the use of a dedicated PICC care team, compared with standard of care, prevent CLABSI in NICU patients?
12. Does the use of “bundled” interventions for central line insertion and maintenance, compared with standard of care, prevent CLABSI in NICU patients?
13. What is the efficacy of prophylactic antimicrobials, compared with standard of care, to prevent CLABSI in NICU patients?
14. What is the efficacy of prophylactic anticoagulant infusions, compared with standard of care, to prevent CLABSI in NICU patients?

Readers wishing to examine the primary evidence underlying the recommendations are referred to the Evidence Review in the body of this document and to the Tables in the Appendix (Appendix, Section C). The Appendix contains clearly delineated search strategies, Evidence Tables containing study-level data, and GRADE Tables which aggregate the overall strength and direction of the evidence organized by outcome.