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ASPIRE HOSPITAL PVT. LTD.

BHUBANESWAR
CLABSI BUNDLE CARE CHECK LIST
Patient Name : IP NO : Ward / Bed NO :
Admission Date : Date of CL Insertion: Date Of Reporting :
Sl No. CRITERIA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Perform hand
hygienic before
insertion &
during care
2 Use maximal
sterile barrier
precaution
3 Perform skin
antisepsis with
chlorhexidine
and alcohol 70 %
solution in
circular motion
4 Use transparent
semi permeable
membrane
(Tegaderm )
dressings
5 Daily site
inspection &
flush with 0.9%
saline / heparin
( at least once in
each shift )
6 Hub /Port
cleaning
immediately
prior to each use
with
chlorhexidine or
70% alcohol
7 Change dressing
every 7 days
unless the
dressing is soiled
or loose
8 Central line
replacement as
per clinical
indication
9 Documentation
Signature of Morning
Nursing Staff Evening
Night

Date Sample Organism Antibiotic Profile


Remarks Sign of Nursing I/C :

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