Catheters Give Life but Sometimes Take It

To improve hand hygiene facility wide, it is wise to include hand hygiene as part of a central line placement checklist. Staffs should keep soap or alcohol-based dispensers in convenient areas, and should make certain that personal protective equipment is located near hand sanitation equipment. IHI also advises staffs to post hand hygiene signs for education purposes, and to foster an environment where reminding each other about hand hygiene is encouraged.

2. Maximal Barrier Precautions

One key to decreasing central line infection risk is to apply maximal barrier precautions when preparing for line insertion. The operator who is placing the central line and everyone assisting him or her should wear a cap, mask, sterile gown and gloves.¹

“The cap should cover all hair and the mask should cover the nose and mouth tightly,” IHI suggests. “These precautions are the same as for any other surgical procedure that carries a risk of infection. For the patient, applying maximal barrier precautions means covering the patient from head to toe with a sterile drape, with a small opening for the site of insertion. Include maximal barrier precautions as part of your checklist for central line placement.”

The equipment should be well-stocked in a cart specifically for central line placements.

3. Chlorhexidine Skin Antisepsis

Chlorhexidine skin antisepsis has been proven to provide better skin antisepsis than other antiseptic agents such as povidone-iodine solutions, IHI researchers claim.

For most kits the technique is to:¹

prepare skin with antiseptic/detergent chlorhexidine 2 percent in 70 percent isopropyl alcohol.

pinch wings on the chlorhexidine applicator to break open the ampule; hold the applicator down to allow the solution to saturate the pad.

press the sponge against the skin and apply chlorhexidine solution using a back-and-forth friction scrub for at least 30 seconds. Do not wipe or blot.

allow antiseptic solution to dry completely before puncturing.

IHI recommends including chlorhexidine antisepsis as part of your checklist for central line placement, and putting chorhexidine antisepsis kits in carts or grab bags specifically for central line equipment.