Central line associated bacteraemia (CLAB) high risk criteria and management
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The following patients in PICU are considered to be at High Risk of Central Line Associated Bacteraemia (CLAB):
- All patients on ECMO
- All patients with an open chest
- All patients with VAD in situ
- Immunosupressed patients:
- Neutropenic patients (PMN <0.5)
- Chronic steroid use
- Chronic protein loss eg nephrotic syndrome, chylothoraces, PLE
- Chronic liver failure
- Known immune deficiency
- CVL in situ > 1 week
- Patient in PICU > 1 week and CVL inserted
- All patients who are colonised with multi- resistant Acinetobacter, ESBL, VRE or MRSA
In addition to the standard infection prevention measures (insertion and maintenance bundles) the following is to be carried out:
- Receive a DAILY full body (to jaw line) wipe with Chlorhexidine wash cloths (Chlorhexidine 2%) following their daily wash. DO NOT apply to broken skin and cease if contact allergy occurs. DO NOT use in infants < 37 weeks gestation.
- Any new CVL inserted must be antimicrobial coated.
- At time of insertion of CVL or at first dressing change, an antimicrobial dressing is placed at the site of all central lines (CVL, vascath, PICC, ECMO cannulae). This does NOT apply to surgically inserted tunnelled or implanted central venous lines (e.g. Hickman or Ports) in situ on admission to PICU.
- Chlorhexidine wash cloths, coated lines, and chlorhexidine dressings are kept in the last aisle of the compactus designated "CLAB HIGH RISK'.
DO NOT apply to broken skin and cease if contact allergy occurs. DO NOT use in infants < 37 weeks gestation.
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- Date last published: 13 March 2013
- Document type: Clinical Guideline
- Services responsible: Paediatric Intensive Care Unit
- Owner: Fiona Miles
- Editor: John Beca
- Review frequency: 2 years
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