Eachyearanestimatedquarterofamillioncentralvenouscatheters (CVCs) are inserted in the UK for monitoring, delivery of drugs or intravenous feeding and blood sampling in patients receiving critical care. CVCs are indispensable in current practice, but the reportedrateofcatheter-associatedbloodstreaminfection(CA-BSI)is high with an incidence varying between 0.46 and 26.5 infections per 1000 catheter days. CA-BSI is an important cause of adverse clinical outcome, with associated morbidity and mortality, and an additional increased economic cost to the National Health Service. Of any clinical speciality Paediatric Intensive Care Units (PICUs) have one of the highest rates of hospital acquired bloodstream infection (BSI), with an estimated 70% caused by CVCs. A number of risk factors which increase the rate of CA-BSI have been described. These include patient related (underlying disease, young age, site of insertion), or CVC related (duration of line, number of lumens, use for parenteral nutrition and blood transfusions) factors. Many of these infections are largely preventable, and numerous quality improvement initiatives and interventions have been introduced in an attempt to reduce the rates of CA-BSI. Preventing central line infections The MichiganeKeystone project targeted specific technical interventionsin103ICUsinUSA,combinedwithsupportforcultural, behavioural and systemic change. This strategy resulted in a major reduction in CA-BSI from 7.7 to 1.4 BSI per 1000 CVC days, with sustained improvement at 3-year follow-up. The Department of Health introduced the Saving Lives initiative with the introduction of high impact interventions in an attempt to reduce healthcare associated infections, and announced a national patient safety initiativebyintroducingasteppedinterventionalprogrammeover2 years (Matching Michigan). CVC insertion and ongoing maintenance care bundles have led to a reduction in CA-BSIs in intensive care units in UK, although at a lower and insignificant rate than in the USA. However this decrease has not been consistently demonstratedinPICUs.ThisisbecauseCVCsaremorelikelytobeinserted in the femoral veins in children for safety reasons, and they tend to be left in for longer periods due to difficulties in venous access. In additiontherearenochildspecificguidelinesduetothelackoftrials in children to provide the evidence for best practice. A study also reported that the rate of CA-BSI is significantly affected by external insertion of the CVC in other hospitals before PICU admission. The rationale for using insertion care bundles is to avoid contamination that would lead to subsequent colonisation of the