TopCDCRecommendations

Infections
toPreventHealthcareAssociated

ToPreventCatheterAssociatedUrinaryTractInfections(CAUTIs)

Insertcathetersonlyforappropriateindications
Leavecathetersinplaceonlyaslongasneeded
Ensurethatonlyproperlytrainedpersonsinsertand
maintaincatheters
Insertcathetersusingaseptictechniqueandsterile
equipment(acutecaresetting)
Followingasepticinsertion,maintainaclosed
drainagesystem
Maintainunobstructedurineflow
HandhygieneandStandard(orappropriateisolation)
Precautions

Alsoconsider:

Alternativestoindwellingurinarycatheterization
Useofportableultrasounddevicesforassessingurine
volumetoreduceunnecessarycatheterizations
Useofantimicrobial/antisepticimpregnatedcatheters

ToPreventSurgicalSiteInfections(SSIs)
Beforesurgery

Administerantimicrobialprophylaxisinaccordance
withevidencebasedstandardsandguidelines
Administerwithin1hourpriortoincision

2hrforvancomycinand
fluoroquinolones
Selectappropriateagentsonbasisof

Surgicalprocedure

MostcommonSSIpathogensfor
theprocedure

Publishedrecommendations
Remoteinfectionswheneverpossible:
Identifyandtreatbeforeelectiveoperation
Postponeoperationuntilinfectionhas
resolved
Donotremovehairattheoperativesiteunlessitwill
interferewiththeoperation;donotuserazors
Ifnecessary,removebyclippingorbyuseof
adepilatoryagent
SkinPrep
Useappropriateantisepticagentand
techniqueforskinpreparation
Maintainimmediatepostoperativenormothermia
Colorectalsurgerypatients
Mechanicallypreparethecolon(Enemas,
catharticagents)
Administernonabsorbableoral
antimicrobialagentsindivideddosesonthe
daybeforetheoperation

DuringSurgery:

AfterSurgery:

NationalCenterforEmergingandZoonoticInfectiousDiseases
DivisionofHealthcareQualityPromotion(DHQP)

KeepORdoorsclosedduringsurgeryexceptasneeded
forpassageofequipment,personnel,andthepatient

Protectprimaryclosureincisionswithsteriledressingfor
2448hrspostop
Controlbloodglucoselevelduringtheimmediatepost
operativeperiod(cardiac)
Measurebloodglucoselevelat6AMonPOD#1
and#2withprocedureday=POD#0
Maintainpostopbloodglucoselevelat
<200mg/dL
Discontinueantibioticswithin24hrsaftersurgeryend
time(48hrsforcardiac)

Alsoconsider
Before surgery:

DuringSurgery:

Redoseantibioticatthe3hrintervalinprocedureswithduration

NasalscreenanddecolonizeonlyStaphylococcus
>3hrs
(*Seeexceptionstothisrecommendation)

aureuscarriersundergoingelectivecardiacandother
procedures(i.e.,orthopaedic,neurosurgeryprocedures
Adjustantimicrobialprophylaxisdoseforobesepatients
withimplants)withpreoperativemupirocintherapy
(bodymassindex>30)
Screenpreoperativebloodglucoselevelsandmaintain
Useatleast50%fractionofinspiredoxygen
tightglucosecontrolPOD#1andPOD#2inpatients
intraoperativelyandimmediatelypostoperativelyin
undergoingselectelectiveprocedures(e.g.,
selectprocedure(s)
arthroplasties,spinalfusions)

*EngelmanR,etal.TheSocietyofThoracicSurgeonsPracticeGuidelineSeries:AntibioticProphylaxisinCardicaSurgery,Part

II:AntibioticChoice.AnnThorSurg2007;83:156976

ToPreventCentralLineAssociatedBloodstreamInfections(CLABSIs)OutsideICUs

Removeunnecessarycentrallines
Followproperinsertionpractices
Facilitateproperinsertionpractices
Complywithhandhygienerecommendations
Useadequateskinantisepsis
Choosepropercentrallineinsertionsites
Performadequatehub/accessportdisinfection
Provideeducationoncentrallinemaintenanceand
insertion

Alsoconsider:

Chlorhexidinebathing

Antimicrobialimpregnatedcatheters

Chlorhexidineimpregnateddressings

ToPreventClostridiumdifficile(C.difficile)Infections

ContactPrecautionsfordurationofdiarrhea
HandhygieneincompliancewithCDC/WHO
Cleaninganddisinfectionofequipmentand
environment
Laboratorybasedalertsystemforimmediate
notificationofpositivetestresults
EducateaboutCDI:HCP,housekeeping,
administration,patients,families

ToPreventMRSAInfections

Assesshandhygienepractices
ImplementContactPrecautions
Recognizepreviouslycolonizedpatients
RapidlyreportMRSAlabresults
ProvideMRSAeducationforhealthcareproviders

Alsoconsider:

ExtenduseofContactPrecautionsbeyonddurationof
diarrhea(e.g.,48hours)
Presumptiveisolationforsymptomaticpatientspending
confirmationofCDI
EvaluateandoptimizetestingforCDI
Implementsoapandwaterforhandhygienebefore
exitingroomofapatientwithCDI
ImplementuniversalgloveuseonunitswithhighCDI
rates
Usesodiumhypochlorite(bleach)containingagentsfor
environmentalcleaning
Implementanantimicrobialstewardshipprogram

Alsoconsider:

Activesurveillancetestingscreeningofpatientsto
detectcolonizationevenifnoevidenceofinfection
Widelyusedandevenrecommendedasacore
preventionstrategybysome,butpreciserole
remainscontroversial
Othernovelstrategies
Decolonization
Chlorhexidinebathing

ForfullpreventiontoolkitsrelatedtotheseandotherHAIsincludingMRSAandC.difficile,visitHAIPreventionToolswebsite
FullCDCguidelinesavailableatHICPACwebsite