ICU care bundles and infection prevention

CLABSI and CAUTI prevention

Reviewed Nov 2026·3 references
New· views rounded down, updated weekly

Insertion and maintenance bundles for central lines and urinary catheters, and nurse-driven removal.

Definition
CLABSI: laboratory-confirmed bloodstream infection in a patient with a central line in place > 2 days without another source. CAUTI: UTI in a patient with an indwelling urinary catheter > 2 days. Both are largely preventable with insertion and maintenance bundles.

At the bedside

  1. 1

    Line insertion checklist

    Hand hygiene, maximal sterile barrier precautions (cap, mask, sterile gown, gloves, full-body drape), observer with authority to stop the procedure.

  2. 2

    Skin antisepsis

    Alcoholic chlorhexidine (> 0.5% CHG in alcohol); allow to dry.

  3. 3

    Site and guidance

    Ultrasound guidance; avoid the femoral site in obese adults when another site is suitable; subclavian has the lowest infection risk.

  4. 4

    Maintenance

    Scrub the hub before every access; CHG-impregnated dressings; change transparent dressings every 7 days (gauze every 2 days) or when soiled/loose; daily CHG bathing in ICU patients.

  5. 5

    Remove

    Daily review of line necessity; remove unnecessary lines promptly; replace lines inserted in emergencies without full asepsis within 48 h.

  6. 6

    Urinary catheter indication

    Insert only for appropriate indications (acute retention, accurate output monitoring in critically ill, perioperative, sacral wounds in incontinent patients, end-of-life comfort).

  7. 7

    Urinary catheter care

    Aseptic insertion; closed drainage system; bag below bladder level and off the floor; unobstructed flow.

  8. 8

    Urinary catheter removal

    Daily review; nurse-driven removal protocols; consider external catheters or intermittent catheterisation; do not screen or treat asymptomatic bacteriuria.

Central line bundle checklist

PhaseElement
InsertionHand hygiene; maximal sterile barrier; alcoholic CHG; ultrasound guidance; best site; checklist with observer
MaintenanceHub disinfection; CHG dressing; dressing change schedule; daily CHG bath; dedicated PN lumen
DailyIs the line needed? Remove if not
Red flag · call your senior now
Fever with pus or erythema at the insertion site, or septic shock with a line in place: take paired blood cultures (line and peripheral) and remove the line.
Pitfall
Sending urine cultures from catheterised patients without symptoms, then treating asymptomatic bacteriuria.
Pitfall
Keeping a central line only for blood sampling convenience.
Pearl
Routine scheduled replacement of central lines or guidewire exchange does not reduce CLABSI.

References

  1. 1

    Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2022;43:553-69.

  2. 2

    Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2023;44:1209-31.

  3. 3

    National Centre for Disease Control, DGHS, MoHFW. National guidelines for infection prevention and control in healthcare facilities. New Delhi: Government of India; January 2020.

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