A nurse is implementing the IHI central-line-associated bloodstream infection (CLABSI) prevention bundle for a patient with a triple-lumen subclavian central venous catheter. From the actions below, select the FIVE that are evidence-based components of the CLABSI prevention bundle.
Select All That Apply
Choose your responses, then check the answer.
Explanation
The IHI central-line bundle includes: hand hygiene, maximal sterile barriers at insertion, chlorhexidine ≥ 0.5% skin antisepsis, daily review of line necessity (and prompt removal), and optimal site selection (subclavian or jugular preferred over femoral). The four extras (routine line change every 5 days, povidone-iodine antisepsis, antibiotic ointment to insertion site, and routine prophylactic antibiotics) are NOT recommended — daily review and prompt removal is the bundle component, not scheduled changes; CHG-alcohol is preferred over povidone for routine antisepsis; antibiotic ointment is no longer recommended for non-tunneled lines; and prophylactic antibiotics increase resistance without reducing CLABSI.
The CLABSI bundle is the most-cited example of a "checklist saves lives" intervention — Pronovost's Michigan ICU study reduced CLABSI rates by ~66%. Memorize: hand hygiene, max barriers, CHG, daily review, site selection. "Scrub the hub" before each access is also part of maintenance.
ICU patient with a triple-lumen subclavian central venous catheter. The unit follows the IHI central-line bundle for CLABSI prevention with daily compliance audits and CLABSI surveillance.
CLABSI bundle — Evidence-based prevention bundle for central-line-associated bloodstream infection.
Maximal sterile barrier — Cap, mask, sterile gown, sterile gloves, and full-body sterile drape during line insertion.
Daily line review — Daily assessment of necessity and prompt removal of unneeded central lines reduces dwell-time CLABSI risk.