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Newsletters: CDC Guidelines on Preventing Catheter-Related Infections
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CDC Guidelines on Preventing Catheter-Related Infections

    Thorough hand washing is critical for catheter care.

In 2011, the Centers for Disease Control (CDC) updated their “Guidelines for the Prevention of Intravascular Catheter-Related Infections.” The guidelines, which replace those issued in 2002, were developed for everyone involved in the placement and care of central venous catheters (CVCs) in any setting (i.e., hospital, outpatient, and home). At eighty-three pages, the complete report is obviously too long for us to reprint here. Also, the guidelines cover intravascular catheters used for many purposes (beyond parenteral nutrition) and in all kinds of settings (including the ICU), and only some of the recommendations pertain specifically to home parenteral nutrition (HPN) consumers and caregivers. We have pulled out the recommendations we think would be of most interest to HPN consumers and list them below.

You can use some of these recommendations at home (such as guidelines for care), but we’ve also included some that are directed specifically to health care providers. We hope these will help you as you are faced with decisions or as you talk to your health care providers. Maybe some will raise questions you’d like to bring to your next appointment. Please note that in a few cases, Oley medical reviewers have felt some clarification on how these guidelines apply to homePN consumers is necessary; their comments are noted with asterisks or another symbol (†) and appear at the end of the article and in Table 1.

Note that in providing just a summary of just some of the recommendations, we are omitting a lot of interesting and important information contained in the report, including the background information explaining the “why” behind the recommendations. If you take the opportunity to review the complete report (available on the CDC Web site), please remember that many of the guidelines were developed for use in critical care or are applicable in hemodialysis or with chemotherapy. The needs and circumstances of these patient populations differ from those of the HPN consumer. For example, their length of time with a CVC may be much shorter and thus long-term access may not be an issue; a CVC used for the administration of chemotherapy drugs may not be as susceptible to some infections as a CVC used for nutrient-rich PN; and, of course, what applies in the hospital often doesn’t apply at home. [Editor’s note: For more information on preventing catheter-related infections, check out the Oley Foundation’s free, interactive MY HPN program online.]



The guidelines are intended to provide evidence-based recommendations for preventing intravascular catheter-related bloodstream infections (CRBSIs). They were prepared by a working group led by the Society of Critical Care Medicine (SCCM). Included in the long list of collaborators are the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), the Infusion Nurses Society (INS), and the CDC. Other professional organizations also represent these disciplines, as well as infectious disease, health care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, and pediatric medicine. The guidelines are truly a multidisciplinary effort.



Each recommendation is categorized as follows:

  • IA. Strongly recommended for implementation and strongly supported by well-designed studies.

  • IB. Strongly recommended for implementation and supported by some studies and a strong theoretical rationale; or an accepted practice (e.g., aseptic technique) supported by limited evidence.

  • IC. Required by state or federal regulations, rules, or standards.

  • II. Suggested for implementation and supported by suggestive studies or a theoretical rationale.

  • Unresolved issue. Evidence is insufficient or no consensus regarding efficacy exists.

The Recommendations

Education, Training, and Staffing
  • Periodically assess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of intravascular catheters. Category IA

  • Designate only trained personnel who demonstrate competence for the insertion and maintenance of peripheral and central intravascular catheters. Category IA

  • Ensure appropriate nursing staff levels in ICUs. Observational studies suggest that a higher proportion of “pool nurses” or an elevated patient-to-nurse ratio is associated with CRBSI in ICUs where nurses are managing patients with CVCs. Category IB*

Selection of CVC Catheters and Sites

  • Use a CVC with the minimum number of ports or lumens essential for the management of the patient. Category IB

  • Promptly remove any intravascular catheter that is no longer essential. Category IA

Hand Hygiene and Aseptic Technique

  • Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs. Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be performed after the application of antiseptic, unless aseptic technique is maintained. Category IB

  • Maintain aseptic technique for the insertion and care of intravascular catheters. Category IB

  • Wear either clean or sterile gloves when changing the dressing on intravascular catheters. Category IC

Catheter Site Dressing Regimens

  • Use either sterile gauze or sterile, transparent, semipermeable dressing to cover the catheter site. Category IA \

  • If the patient is diaphoretic [or sweating excessively] or if the site is bleeding or oozing, use a gauze dressing until this is resolved. Category II

  • Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled. Category IB

  • Do not use topical antibiotic ointment or creams on insertion sites, except for dialysis catheters, because of their potential to promote fungal infections and antimicrobial resistance. Category IB

  • Do not submerge the catheter or catheter site in water. Showering should be permitted if precautions can be taken to reduce the likelihood of introducing organisms into the catheter (e.g., if the catheter and connecting device are protected with an impermeable cover during the shower). Category IB

  • Replace transparent dressings used on tunneled or implanted CVC sites no more than once per week (unless the dressing is soiled or loose), until the insertion site has healed. Category II

  • No recommendation can be made regarding the necessity for any dressing on well-healed exit sites of long-term cuffed and tunneled CVCs. Unresolved issue

  • Ensure that catheter site care is compatible with the catheter material. Category IB

  • Monitor the catheter sites visually when changing the dressing or by palpation through an intact dressing on a regular basis, depending on the clinical situation of the individual patient. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or bloodstream infection, the dressing should be removed to allow thorough examination of the site. Category IB

  • Encourage patients to report any changes in their catheter site or any new discomfort to their provider. Category II

Catheter Securement Devices

  • Use a sutureless securement device to reduce the risk of infection for intravascular catheters. Category II**

Systemic Antibiotic Prophylaxis

  • Do not administer systemic antimicrobial prophylaxis routinely before insertion or during use of an intravascular catheter to prevent catheter colonization or CRBSI. Category IB

Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush, and Catheter Lock Prophylaxis

  • Use prophylactic antimicrobial lock solution in patients with long-term catheters who have a history of multiple CRBSI despite optimal maximal adherence to aseptic technique. Category II

Replacement of CVCs, Including PICCs

  • Do not routinely replace CVCs or PICCs to prevent CRBSIs. Category IB
  • Do not remove CVCs or PICCs on the basis of fever alone. Use clinical judgment regarding the appropriateness of removing the catheter if infection is evidenced elsewhere or if a noninfectious cause of fever is suspected. Category II***

Needleless Intravascular Catheter Systems

  • Ensure that all components of the system are compatible to minimize leaks and breaks in the system. Category II
  • Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices. Category IA
  • Use a needleless system to access IV tubing. Category IC
  • When needleless systems are used, a split septum valve may be preferred over some mechanical valves due to increased risk of infection with the mechanical valves. Category II


Notes from Oley medical reviewers:

*This should apply to any nursing unit that deals with CVCs.

** Stat locks [sutureless securement devices] only work with PICCs and Power Hickmans. The device is needed for the life of the PICC and until the Hickman cuff becomes anchored. It cannot be used in a silicone Hickman (which is often the preferred long-term device) because that CVC does not have the adapter molded in the catheter like the PICC and Power Hickman. If you have a tunneled cuffed central line, the stitch should be removed in approximately four weeks since the stitch can promote a local infection.

***A CVC should not be removed if symptoms are mild and it is possible that the CVC is not the source of these symptoms. An infected tunneled CVC can often be treated without removal, but this requires resolution of your fever and negative blood cultures while being treated with antibiotics. If you have a PICC that becomes infected, it will usually need to be removed to treat the infection. For implanted catheters, the specific location of the infection (bloodstream versus the pocket containing the port) will determine whether the catheter will need to be removed. If you have a high fever or are very ill, your doctor may decide to remove your CVC, even before blood cultures are completely processed, as CVC removal is one way to treat an infected CVC. Certain types of infection (for example, fungal) are extremely difficult to clear and typically require catheter removal.

Thanks to the Centers for Disease Control and Oley Trustees, Darlene Kelly, MD, PhD; and Douglas Seidner, MD, for their assistance with this article.

LifelineLetter, January/February 2012

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This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.


Updated in 2015 with a generous grant from Shire, Inc. 


This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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