The Case For Maximal Barrier Precautions

It is estimated that a total of 250,000 cases of Catheter Related-Bloodstream Infection (CRBSI) occur each year with an attributable mortality rate estimated at 12%-25% for each infection.1

According to the Institute for Healthcare Improvement (IHI), institutions can virtually eliminate the chief sources of CLABSI with:

  • Full sterile barrier precautions
  • Consistent basic sanitation
  • Bundled, evidence-based infection-prevention tools

Maximal Barrier Precautions Defined

According to the IHI, “… maximal barrier precautions means strict compliance with hand hygiene and wearing a cap, mask, sterile gown, and sterile gloves. The cap should cover all hair and the mask should cover the nose and mouth tightly. These precautions are the same as for any other surgical procedure that carries a risk of infection. For the patient, applying maximal barrier precautions means covering the patient from head to toe with a sterile drape, with a small opening for the site of insertion.“2

The Risk—and Reward

At least two studies of central line insertions have documented the risk of not applying maximal barrier precautions:

  • Mermel et al. demonstrated that the odds ratio was 2.2 times greater for infection without maximal barrier precautions.3
  • Raad et al. demonstrated a 6.3 times greater likelihood for infection without precautions.4

Conversely, the adjacent chart demonstrates how institutions can dramatically reduce their rates of CLABSIs by employing maximal barrier precautions as part of the IHI's “CVC bundle”: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection and daily review of line necessity, with prompt removal of unnecessary lines.

Berenholtz, S.M., Pronovost, P.J., Lipset, P.A., et al. "Eliminating Catheter-Related Bloodstream Infection in the Intensive Care Unit." Critical Care Medicine, 2004, Vol. 32, pp. 2014–2020.


  1. O'grady, N.P., Alexander, M., Burns L.A., Dellinger, P., Garland, J., Heard, S.O., Lipsett P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A, Rupp, M.E., Saint, S.. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. The Centers for Disease Control. Accessed May 16, 2011. 
  2. Getting Started Kit: Preventing Central Line Infections. Institute for Healthcare Improvement, 2004: 1-45. 
  3. Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: A prospective study utilizing molecular subtyping. Am J Med. Sep 16 1991;91(3B):197S-205S. 
  4. Raad, II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol. Apr 1994;15(4 Pt 1):231-238.
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