Disclaimer: This post is for academic purposes only. Please read the original document if you intend to use them for clinical purposes.
This document summarizes the key aspects of the implementation guide for Catheter-Associated Blood Stream Infections (CABSI) prevention in adults , published by the Association for Professionals in Infection Control and Epidemiology (APIC) in June 2025. It responds to the evolving landscape of infection prevention by shifting the current surveillance scope from only Central line-associated bloodstream infections (CLABSIs) to all CABSIs. It also introduces Hospital-Onset Bacteremia and Fungemia (HOB), acknowledging it as the intended future of BSI surveillance, with CABSI being a subset of HOB.
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Definitions:
- Central Line-Associated Bloodstream Infection (CLABSI): The most narrowly defined term, referring specifically to BSIs associated with a Central venous access device (CVAD).
- Catheter-Associated Blood Stream Infections (CABSI): A broader term that includes infections associated with all types of VAD (Vascular access devices). A standardized case definition for CABSI is currently under development, and the guide provides a suggested definition extrapolated from the NHSN CLABSI definition.
- Hospital-Onset Bacteremia and Fungemia(HOB): The broadest surveillance category, capturing all hospital-onset BSIs regardless of any device association.
- The guide explicitly excludes specific device-associated BSIs such as Extra-corporeal Membrane Oxygenation (ECMO) and Hemodialysis Reliable Dialysis Outflow (HERO) catheters, and does not specifically address pediatric or neonatal patient populations. It also differentiates between clinical, claims-based, and surveillance definitions of BSIs.
Core Components:
An effective CABSI prevention program requires a multidisciplinary team, including clinical leadership, IPs, vascular access specialists, physicians, and nursing. Key elements include:
- Risk Assessment: Systematically identifying and evaluating existing and potential risks based on factors like current/historical CABSI rates, VAD utilization, and patient population risks.
- Equipment and Supplies: Ensuring appropriate, well-organized, and accessible supplies for VAD insertion and maintenance, including consideration of catheter type, insertion kits, antisepsis, dressings, and securement. The guide notes the Aseptic Non Touch Technique (ANTT®) has gained traction for aseptic procedures.
- Education, Training, and Competency Assessment: Essential for all healthcare personnel involved in VAD care, covering topics from appropriate VAD ordering and insertion techniques to maintenance, blood culture collection, and patient hygiene.
- Policies and Procedures: Establishing facility-specific guidelines based on EBGs (Evidence-based guidelines) to communicate expectations for CABSI prevention practices.
- Information Technology: Leveraging EMR software for prompts/alerts and compliance monitoring, infection prevention surveillance software, dashboards, and exploring AI (artificial intelligence) for enhanced surveillance and data analysis.
Best Practices:
The guide distinguishes between Essential practices (strongest evidence, often extrapolated from CVAD research to all VADs) and Additional Practices (growing but limited evidence base).
- Essential Insertion elements:
- Using VADs only when necessary
- utilizing vascular visualization technology
- performing clinical and venous assessments
- appropriate insertion practices (hand hygiene, aseptic/sterile technique, sterile supplies)
- ensuring appropriate securement
- Essential Maintenance elements:
- Appropriate maintenance practices (hand hygiene, aseptic/sterile technique, sterile supplies)
- ensuring clean/dry/intact dressings (with CHG-containing dressings for CVADs)
- disinfecting catheter access points, exchanging administration sets at appropriate intervals
- daily CHG treatment for adult ICU patients, proper blood collection technique
- maintaining VAD patency
- removing VADs when no longer clinically indicated
- Additional Practices:
- VAD insertion and care bundles
- utilizing custom kits
- employing additional trained personnel (e.g. vascular access teams)
- leveraging advanced insertion technology
- considering new materials for insertion and maintenance
Monitoring:
Monitoring is crucial to ensure quality care and patient safety:
- Outcome Measures: Determine if program goals are met, including:
- CABSI rates
- CLABSI rates
- CLABSI Standardized Infection Ratios (SIR)
- CVAD Standardized Utilization Ratios (SUR)
- Cumulative Attributable Difference (CAD)
- Targeted Assessment for Prevention (TAP) reports
- Process Measures: Monitor adherence to policies and procedures. Specific metrics cover insertion site frequency, device type frequency, necessity indications, dwell time, blood culture positivity/organism frequency, and CHG treatment compliance. Methods include:
- Direct observation
- Point prevalence rounding
- Staff interviews
- Automated EMR metrics
- Manual chart review
- Epidemiologic Questions: A comprehensive “deep dive” into CABSI cases can identify trends related to patient population, insertion criteria (e.g. inserter, VAD type, insertion site, dwell time), maintenance criteria, microbiology results, materials, and healthcare worker training.
Conclusion:
The guide’s primary purpose is to provide information and toolsto reduce the risk of infection due to Catheter-associated bloodstream infections (CABSI) in various practice settings for adults. It is specifically designed to help IPs (Infection Preventionists) apply current scientific knowledge and best practices to achieve targeted outcomes and enhance patient safety .
Citation: “Preventing Catheter-Associated Bloodstream Infections (CABSI) in Adults” APIC – Association for Professionals in Infection Control and Epidemiology. 2025
