Position Statement of the Hong Kong Society of Critical Care Medicine

Dr CHAN Wai Ming, on behalf of the HKSCCM 
This position statement was endorsed by the HKSCCM Council in Feb 2010

1. Central line: A vascular infusion device terminates at or close to the heart or in one of the great vessels.

a、 These include:
- Internal jugular, subclavian, femoral venous catheters, and
- peripherally inserted central catheter (PICC)
b、 and Exclude:
- Pacemaker wires or other non-infusion devices inserted into central blood vessels or heart and arterial lines,
- external jugular vein,
- long term venous access devices eg Hickman, Broviac catheter.

2. Timing of infection in ICU
a、 Patient who has been hospitalized in ICU for >48 hours.
b、 Patients within 48 hours of discharge from ICU

3. Catheter Associated Blood Stream Infection (CABSI):
Laboratory confirmed Blood Stream Infection in patients with central line being used within 48 hours period before its onset.
Laboratory confirmed BSI, with
a、 One of : Temp > 38°C, Chills, Hypotension SBP<= 90mmHg AND
b、 organism cultured from blood is not related to an infection at another site, AND
c、 Common skin contaminant is cultured from TWO or more blood cultures drawn on separate occasions

4. Recommended Specimen collection for suspected line sepsis

A. Blood Culture
 Send 2 sets (1 pair) of blood culture from different site simultaneously.
 It is recommended to determine differential period of blood culture.
 In case only 1 blood culture is taken, it is recommended to repeat culture within 24 hours, especially when blood smear result is positive.

B. Catheter tip culture :
 it should be taken for culture only when there are local signs of catheter infection.
 Routine Catheter tip culture is not recommended.
 Method of specimen collection.
1. Send catheter exit site swab for culture if presence of pus
2. Remove catheter, cut catheter tip with sterile scissor
3. Put the catheter tip into a sterile container and sent for at least semi-quantitative culture.

C. Interventions to Control CABSI :
The following 5 point care bundle is recommended.
a、 Hand Hygiene
b、 Maximal Barrier Precautions :
 An adequate sterile drape with key hole is recommended
 Sterile gloves, gown, mask and cap are recommended.
c、 Skin Antisepsis :
 Recommends Skin preparation with 2% Chlorhexidine in 70% Ethanol solution.
d、 Optimal Catheter Site Selection :
 Subclavian Vein is the Preferred Site for Non-Tunneled Catheters, unless there are contra-indications to use the subclavian vein.
e、 Daily Review of Line Necessity with Prompt Removal of Unnecessary Lines.
 Remove catheter within 24 hours if not used for the followings indications :
 Large volume fluid challenge
 Inotropes / Vasopresssors
 CVP monitoring
 Difficult peripheral line access
 Renal replacement therapy
 Total Parental nutrition

1 Horan TC. CDC/ NHSN surveillance definition of health care- associated infection and criteria for specific types of infections in the acute care setting, Am J Infect Control 2008 ; 36: 309-32.
2 National Healthcare Safety Network (NHSN) , data summary from January 2006 through June 2007. Am J Infect Control 2007; 35: 290-301.
3 Rosenthal VD, Maki DG et al. International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control 2008;36 : 627-37.
4 O’ Grady NP. Guidelines for the Prevention of Intravascular Catheter- Related Infections, MMWR. Aug 9, 2002 / 51(RR10); 1-26
5 Protecting 5 Millions lives : Getting started kit : prevent Central Line infections how to guide.
Link :

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