Prevention Of Catheter-related Bloodstream Infections Research Articles

Development of antimicrobial peptides for catheter-related bloodstream infectionprevention

Central venous catheters are used in many medical procedures to deliver critical and lifesaving treatments, such as antibiotics and chemotherapy agents. However, central line-associated bloodstream infections (CLABSIs) associated with these devices negatively impact over 100,000 patients per year and are extremely expensive to treat. When infections arise on implanted biomaterials, they are treated with systemic antibiotics, debridement, and implant removal. Unfortunately, the high local antibiotic concentrations needed to kill colonized bacteria are only achieved over a short time, cause cytotoxicity, and can promote antibacterial resistance. Therefore, it is currently believed that proactive methods of infection management will be superior to reactive methods. As an alternative to traditional antibiotics or to device removal, antimicrobial peptides (AMPs) represent a novel way to prevent and treat infections. AMPs are short, cationic molecules found naturally in the innate immune systems of many species, and they have broad spectrum antimicrobial activity. AMPs use fundamentally different mechanisms to kill bacteria than conventional antibiotics, reducing the threat of bacterial resistance.

Chlorhexidine-Impregnated Dressing for Prevention of Catheter-Related Bloodstream Infection

Objective:To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter–related colonization and catheter-related bloodstream infection using meta-analysis.Data Sources:Multiple computerized database searches supplemented by manual searches including releva

TEMPORARY HEMODIALYSIS

Catheter related blood stream infections (CRBSI) in patients undergoinghemodialysis frequently results in significant morbidity and mortality. Attempts at prevention ofCRBSI by catheter lock antibiotics, antibiotic combinations or solutions including Taurolidinehave emerged over years. Objectives: To determine the role of taurolidine lock in presentationof Catheter related infection in hemodialysis. Design: Multicentre un-builded, randomizedcontrolled, non-inferiority trail. Period: Jul 2012 to Dec 2013. Setting: Department of Nephrology,Fatima Memorial Hospital UHS Lahore. Methods: It was a multicentre, un-blinded, randomizedcontrolled, non-inferiority trial. Results: Out of 95 patients, total of 38 patients were randomizedinto two groups. In group A catheters were locked with Taurolidine 2% and Heparin (5000IU/ml) equal to the catheter volume according to the protocol. In group B (control) catheters werelocked with Heparin alone. 36 patients completed the study protocol. For primary end pointanalysis (30 days) the mean duration of catheter days was 27.25 + 5.5 days (median 30 days).During this period of follow up only one patient from Group B had CRBSI resulting in a pointincidence of CRBSI of 2.7%. Conclusions: Catheter lock with Taurolidine 2% in combinationwith heparin compared to heparin alone had no additional benefit in prevention of CRBSI. Thishowever needs to be evaluated in a larger study using non cuffed temporary vascular access(TVA).

Patient safety: the doctor's perspective.

Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Beyond their economic cost and their cost in human lives, errors cause loss of trust in the healthcare system by patients and diminished satisfaction by both patients and health professionals. There are many evidence-based safety-oriented behaviours and interventions that are easily implemented, such as ultrasound-guided central venous catheter insertion, prevention of catheter-related bloodstream infection and more. In vascular access, the development of research in patient safety has raised a variety of issues requiring study in order to provide the optimal patient safety approach. Patients are major contributors to their own safety, and as such, physicians should develop a new approach to involve them in the cycle of decision making through every step of their treatment. There are many opportunities along this path for the patient to be engaged in safety behaviours and for the access team to ensure such behaviours by employing simple strategies. The advent of the access centre, based on multidisciplinary teamwork, has enhanced the potential to improve patient safety by prevention of errors in planning and performing access surgery, avoiding delay in treatment of access malfunction and improving communication between the team members. However, a significant effort in research is still needed in order to implement intervention by evidence-based data focused on patient safety.

Domestic cluster nursing prevention of deep venous catheter-related bloodstream infections:A Meta-analysis

Objective To systematically review the effect of cluster-based nursing for prevention of deep venous catheter-related bloodstream infection.Methods We searched the domestic literature,using RevMan5.2 software for statistical processing.Results A total of 13 qualified literature was included.Its combined OR=0.33,95％CI=(0.26,0.43),indicating that the cluster-based nursing could significantly reduce deep venous catheter-related bloodstream infection rate.Conclusions Cluster-based nursing is a practical nursing intervention,which should be promoted in clinical practice. Key words: Cluster-based nursing; Deep vein catheter-related bloodstream infections; Meta analysis

Biofilm-based central line-associated bloodstream infections.

Different types of central venous catheters (CVCs) have been used in clinical practice to improve the quality of life of chronically and critically ill patients. Unfortunately, indwelling devices are usually associated with microbial biofilms and eventually lead to catheter-related bloodstream infections (CLABSIs).An estimated 250,000-400,000 CLABSIs occur every year in the United States, at a rate of 1.5 per 1,000 CVC days and a mortality rate of 12-25 %. The annual cost of caring for patients with CLABSIs ranges from 296 million to 2.3 billion dollars.Biofilm formation occurs on biotic and abiotic surfaces in the clinical setting. Extensive studies have been conducted to understand biofilm formation, including different biofilm developmental stages, biofilm matrix compositions, quorum-sensing regulated biofilm formation, biofilm dispersal (and its clinical implications), and multi-species biofilms that are relevant to polymicrobial infections.When microbes form a matured biofilm within human hosts through medical devices such as CVCs, the infection becomes resistant to antibiotic treatment and can develop into a chronic condition. For that reason, many techniques have been used to prevent the formation of biofilm by targeting different stages of biofilm maturation. Other methods have been used to diagnose and treat established cases of CLABSI.Catheter removal is the conventional management of catheter associated bacteremia; however, the procedure itself carries a relatively high risk of mechanical complications. Salvaging the catheter can help to minimize these complications.In this article, we provide an overview of microbial biofilm formation; describe the involvement of various genetic determinants, adhesion proteins, organelles, mechanism(s) of biofilm formation, polymicrobial infections, and biofilm-associated infections on indwelling intravascular catheters; and describe the diagnosis, management, and prevention of catheter-related bloodstream infections.

Survey on the current situation of prevention and control of central venous catheter-related bloodstream infections in ICU of three-level hospital and control strategy

Objective To understand the current situation of the prevention and control of central venous catheter-related bloodstream infections （ CRBSI ） in ICU of three-level hospital , and explore the countermeasures .Methods The self-designed questionnaires were used in the study .The prevention and control and the quality management of ICUCRBSI at present in eight hospital were investigated ; and the cognition, the agree degree and the behavior of the related knowledge of the prevention and control of CRBSI in 252 nurses were also investigated .Results Six hospitals in eight hospitals had the standard operating procedure for the prevention and control of CRBSI , and two hospitals had the special check list for the maintenance of central venous catheter （ CVC） .The special prevention and control of CRBSI supported by the guideline of CDC in the USA was poorly carried out in the different hospital .The scores of the cognition , the agree degree and the behavior of the related knowledge of the prevention and control of CRBSI in 252 nurses were respectively （55.88 ±7.46）, （20.21 ±1.48） and （72.59 ±6.83）.Conclusions The three-level hospital in one city is lack of the standard operating procedure for the prevention and control of CRBSI , the check list for CVC catheter and maintenance .The medical staff should strengthen the training of the prevention and control of CRBSI , and increase the behavior compliance so as to decrease the incidence of CRBSI and improve the successful rate of rescue in the critically ill patients . Key words: Intensive care unit; Central venous catheter-related bloodstream infections; Quality management; Questionnaire survey

Inhibition of heparin precipitation, bacterial growth, and fungal growth with a combined isopropanol–ethanol locking solution for vascular access devices

BackgroundClinical reports of ethanol-lock use for the prevention of catheter-related bloodstream infections have been marked by the occurrence of serious catheter occlusions, particularly among children with mediports. We hypothesized that precipitate forms when ethanol mixes with heparin at the concentrations relevant for vascular access devices, but that the use of a combination of two alcohols, ethanol and isopropanol, would diminish heparin-related precipitation, while retaining anti-bacterial and anti-fungal effects. MethodsHeparin (0–100units/mL) was incubated in ethanol–water solutions (30%–70% vol/vol) or in an aqueous solution containing equal parts (35% and 35% vol/vol) of isopropanol and ethanol. Precipitation at temperatures from 4 to 40°C was measured in nephelometric turbidity units using a benchtop turbidimeter. Growth of Escherichia coli, Staphylococcus aureus, and Candida albicans colonies were measured following exposure to solutions of ethanol or isopropanol–ethanol. Groupwise comparisons were performed using analysis of variance with Bonferroni-corrected, post-hoc T-testing. ResultsSeventy percent ethanol and heparin exhibit dose-dependent precipitation that is pronounced and significant at the concentrations typically used in mediports (p<0.05). Precipitate is significantly reduced by use of a combined 35% isopropanol–35% ethanol solution rather than 70% ethanol (p<0.05), while maintaining the solution's anti-bacterial and anti-fungal properties. On the other hand, although ethanol solutions under 70% form less precipitate with heparin, such concentrations are also less effective at bacterial colony inhibition than solutions of either 70% ethanol or 35% isopropanol–35% ethanol (p<0.05). ConclusionsA combined 35% isopropanol–35% ethanol locking solution inhibits bacterial and fungal growth similarly to 70% ethanol, but results in less precipitate than 70% ethanol when exposed to heparin. Further study of a combined isopropanol–ethanol locking solution for the prevention of catheter-related bloodstream infections should focus on the determination as to whether such a locking solution may reduce the rate of precipitation-related catheter occlusion, and whether it may be administered with low systemic toxicity.

Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis*.

To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and catheter-related bloodstream infection using meta-analysis. Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. Randomized controlled trials evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and catheter-related bloodstream infection. Data were extracted on patient and catheter characteristics and outcomes. Nine randomized controlled trials met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced prevalence of catheter-related bloodstream infection (random effects relative risk, 0.60; 95% CI, 0.41-0.88, p = 0.009). The prevalence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects relative risk, 0.52; 95% CI, 0.43-0.64; p < 0.001). There was significant benefit for prevention of catheter colonization and catheter-related bloodstream infection, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, catheter-related bloodstream infection and warrants routine use in patients at high risk of catheter-related bloodstream infection and central venous catheter or arterial catheter colonization.

The management of central venous catheters and infection control: is it time to change our approach?

Catheter related bloodstream infections (CR-BSIs) can lead to a number of serious conditions for the patient, including death. There is much recent evidence both in the UK and abroad which identifies the sources of CR-BSIs, yet they continue to occur. This article seeks to review some of the current evidence in relation to the prevention of CR-BSIs at insertion point.

Ethanol Lock Therapy (E-Lock) in the Prevention of Catheter-Related Bloodstream Infections (CR-BSI) after Major Heart Surgery (MHS): A Randomized Clinical Trial

BackgroundLock-therapy with antimicrobials has been used for the treatment and prevention of catheter-related bloodstream infections (CR-BSI). Experiences with Ethanol-Locks (E-locks) have included therapeutic interventions with variable results. Patients undergoing Major Heart Surgery (MHS) are a high-risk population for CR-BSI.The aim of this study was to assess the efficacy and tolerance to E-Locks in the prevention of CR-BSI of patients undergoing MHS.Methods and FindingsThis is an academic, prospective, randomized, non-blinded and controlled clinical trial assessing the incidence of CR-BSI of patients with E-locks (E-lock) and the tolerance to the procedure in comparison with patients receiving conventional catheter-care (CCC). Patients undergoing MHS with intravascular catheters for more than 48 hours were randomly assigned into treatment or control group by a computer-generated list of randomly assigned numbers. In the treatment group, all their catheter lumens were locked with an ethanol solution at 70% for two hours, every three days (E-Locks). The control group received conventional catheter-care (CCC).Overall, 200 patients with 323 catheters were included in the study, which was stopped after 10 months due to adverse events. Of them, 179 catheters (113 patients) had E-Locks and 144 catheters (87 patients) were CCC. Euroscore Surgical Risk in both groups was 4.04 vs 4.07 p = 0.94 respectively. The results for the E-Locks and CCC were as follows: Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2 (p = 0.33), catheter tip colonization 14 (7.8%) vs 6 (4.2%) patients (p = 0.17), median length of hospital stay, 15 vs 16 days (p = 0.77). Seven patients (6.19%), all in the ethanol branch, had to discontinue the trial due to intolerance or adverse events.ConclusionsWe do not recommend prophylaxis of CR-BSI with ethanol-lock on a routine basis in patients undergoing Major Heart Surgery.Trial RegistrationClinical Trials.gov NCT01229592

Taurolidine Lock Solutions for the Prevention of Catheter-Related Bloodstream Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundCatheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs.MethodsWe conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity.ResultsSix randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21–0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G−) bacteria (P = 0.004; RR, 0.27; CI, 0.11–0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15–1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75–5.28).ConclusionsThe use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings.

Citrate Versus Heparin Lock for Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Citrate solution has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a citrate lock is superior to a heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive. A systematic review and meta-analysis was performed by searching in PubMed, EMBASE, Ovid, the Cochrane Library, and Web of Science databases and major nephrology journals. Patients receiving hemodialysis with central venous catheters. Randomized controlled trials comparing citrate locks with heparin locks in hemodialysis patients with central venous catheters. Locking central venous catheters with citrate locks. Primary outcomes include catheter-related bloodstream infection (CRBSI), exit-site infection, catheter removal for poor flow, and thrombolytic treatment. 13 randomized controlled trials (1,770 patients, 221,064 catheter-days) met the inclusion criteria. Pooled analyses found that citrate locks could significantly reduce the incidence of CRBSI (risk ratio [RR], 0.39; 95% CI, 0.27-0.56; P < 0.001). Subgroup analysis showed that antimicrobial-containing citrate locks (citrate + gentamicin, citrate + taurolidine, and citrate + methylene blue + methylparaben + propylparaben) were superior to heparin locks in the prevention of CRBSI (P < 0.001, P = 0.003, and P = 0.008, respectively), whereas citrate alone failed to show a similar advantage (P = 0.2). Low- (1.04%-4%) to moderate-concentration (4.6%-7%) citrate locks were associated with decreased CRBSI incidence (P < 0.001 and P = 0.003, respectively), but patients receiving high-concentration (30%-46.7%) citrate and heparin locks had similar incidences (P = 0.3). The incidence of bleeding episodes (RR, 0.48; 95% CI, 0.30-0.76; P = 0.002) was significantly lower in patients receiving citrate locks, whereas both groups were similar in terms of exit-site infection (P = 0.2), catheter removal for poor flow (P = 0.9), thrombolytic treatment (P = 0.8), all-cause death (P = 0.3), catheter thrombosis (P = 0.9), mean catheter duration (P = 0.2), CRBSI-free catheter survival (P = 0.2), and catheter-related readmission (P = 0.5). All studies used in the meta-analysis were performed in Western countries. The applicability of our findings to other regions remains to be clarified. An antimicrobial-containing citrate lock is better than a heparin lock in the prevention of catheter-related infection, while citrate alone fails to show a similar advantage. Citrate locks of low to moderate concentrations, rather than high concentration, were superior to heparin locks in preventing CRBSI. Citrate locks also might decrease bleeding episodes. No difference has been identified in the efficacy to prevent exit-site infection or preserve catheter patency between citrate and heparin locks.

Impact of a National Multimodal Intervention to Prevent Catheter-Related Bloodstream Infection in the ICU

Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs. Prospective time series. A total of 192 ICUs throughout Spain. All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010). Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture. The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16-18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p<0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39-0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type. Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems.

Catheter-related infections in patients on home parenteral nutrition

Long-term parenteral nutrition in the community is a practice that is growing steadily in the UK. Catheter-related bloodstream infections (CRBSI) in these patients is one of the major causes of morbidity and re-hospitalisation. The prevention of CRBSI impacts the quality of life and outcomes of these patients.

Effect of catheter record on the prevention of catheter-related bloodstream infection in RICU

Objective To understand the status of catheter-related bloodstream infection in Respiratory Intensive Care Unit (RICU),and explore the effect of catheter record in the prevention of catheter-related bloodstream infection (CRBSI) in RICU.Methods A quasi-experimental study was used in the study.The patients with the central venous catheters in the Respiratory Intensive Care Unit of Grade Ⅲ hospital in Beijing were enrolled.The control group was given normal care,and the intervention group was given catheter record and other nursing intervention.The infection rate of CRBSI was compared between two groups after intervention.Results Ninety-four patients were completed date collection,43 patients were in intervention group and 51patients were in control group.The infection of CRBSI was five cases (9.8％) in the control group,and 0 case in the intervention group,and the difference was statistically significant (x2 =4.453,P ＜ 0.05).The thousand-day-infection rate of CRBSI was 0.00 in the intervention group,and 4.36‰ in the control group.The catheter logs which were completely recorded were 31 (72％),and the catheter logs which were not completely recorded were 12 (28％).Conclusions A serious of nursing intervention measures including setting up catheter record,aseptic operation and pipeline observation and maintenance can decrease the infection rate of CRBSI. Key words: Catheterization, central venous ; Catheter-related bloodstream infection ; Catheter record

Prevention of central venous catheter infections: A survey of paediatric ICU nurses' knowledge and practice

Central venous catheters are important in the management of paediatric intensive care unit patients, but can have serious complications which worsen the patients' health, prolong hospital stays and increase the cost of care. Evidence-based recommendations for preventing catheter-related bloodstream infections are available, but it is unknown how widely these are known or practiced in the paediatric intensive care environment. To assess nursing knowledge of evidence based guidelines to prevent catheter-related bloodstream infections; the extent to which Australia and New Zealand paediatric intensive cares have adopted prevention practices; and to identify the factors that encouraged their adoption and improve nursing knowledge. Cross-sectional surveys using convenience sampling. Tertiary level paediatric intensive care units in Australia and New Zealand. Paediatric intensive care nursing staff and nurse managers. Between 2010 and 2011, the 'Paediatric Intensive Care Nurses' Knowledge of Evidence-Based Catheter-Related Bloodstream Infection Prevention Questionnaire' was distributed to paediatric intensive care nursing staff and the 'Catheter-Related Bloodstream Infection Prevention Practices Survey' was distributed to nurse managers to measure knowledge, practices and culture. The questionnaires were completed by 253 paediatric intensive care nurses (response rate: 34%). The mean total knowledge score was 5.5 (SD=1.4) out of a possible ten, with significant variation of total scores between paediatric intensive care sites (p=0.01). Other demographic characteristics were not significantly associated with variation in total knowledge scores. All nursing managers from Australian and New Zealand paediatric intensive care units participated in the survey (n=8; response rate: 100%). Wide practice variation was reported, with inconsistent adherence to recommendations. Safety culture was not significantly associated with mean knowledge scores per site. This study has identified that there is variation in the infection prevention approach and nurses' knowledge about catheter-related bloodstream infection prevention. The presence of an improved safety culture, years of paediatric intensive care experience and higher qualifications did not influence the nurses' uptake of recommendations, therefore further factors need to be explored in order to improve understanding and implementation of best practice.

Prevention of Catheter-Related Blood Stream Infections (CRBSI)

The use of temporary or tunneled central venous catheters (CVC) is increasing worldwide in hemodialysis patients, but their numerous and potentially severe complications should be taken into account. Among the possible complications, infections are certainly those with the greater impact on morbidity and mortality. Catheter-related infections can affect the CVC exit site, the subcutaneous tunnel or, in the most severe cases, can induce bacteremia and sepsis (CRBSI, catheter-related blood stream infections). CRBSI prevention is of the utmost importance and can be achieved through educational activities for the dialysis personnel and through the use of specific protocols for CVC insertion and management. Indeed, it has been demonstrated that these measures allow a significant reduction of the number of CRBSI, to less than 1 episode per 1,000 catheter days.

PWE-187 Ethanol and Taurolidine Line Locks for the Reduction and Treatment of Catheter Related Blood Stream Infections in Paediatric Intestinal Failure: A Systematic Review

IntroductionPaediatric intestinal failure (PIF) patients are often dependent on home parental nutrition (HPN) nd rely upon a central venous catheter (CVC) for its administration. There is a significant risk of...

Design and application of quality improvement checklist of catheter-related blood stream infection in the intensive care units

Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU. Key words: Forms and records control; Intensive care unit; Quality control; Catheter-related blood stream infection