Prevention of catheter-related infection: toward zero risk?

This review identifies important findings in the recent literature related to the prevention of central line-associated bloodstream infection (CLABSI).

CLABSI rates obtained through surveillance programs have decreased in recent years. Reasons for this are multifactorial: bundle interventions for practice change; technology; and pressure from benchmarking and public reporting. Many studies on the successful use of bundle strategies have been published in the past 2 years, whereas technology has somewhat disappeared from the literature. Success stories made CLABSI prevention the example of healthcare-associated infection prevention. The overwhelming success of practice change together with emerging public awareness confronts hospitals with serious implementation challenges. Fortunately, a number of implementation guidance articles were published recently, which allow hospitals to detect and overcome implementation barriers.

The efforts made for CLABSI prevention exemplify not only the complexity of the problem but also the creativity and--most recently--success. Although 'zero' risk may not seem a realistic goal, the number of hospitals approaching this idealistic threshold is growing. The evidence is now clear that CLABSI can be reduced most effectively by 'state-of-the-art' insertion technique and catheter care. The question today is not 'what to do' but 'how to do it'.