Bibliographic information
GuidelineGuidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: part 2: central venous catheters
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
WHO suggests using either a closed access or an open-access central venous catheter (CVC) hub system in adults, adolescents, children and neonates. (Short- and long-term catheters) (All population)
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- Closed-access hub systems are those that allow intravascular access using a needleless device and are designed to prevent blood leakage and air entry and to reduce the risk of pathogen entry into the device access site (11).
- Open-access hub systems are those that are directly accessible using a routine syringe (11). When accessed, the device is potentially open to the environment and may be associated with blood leakage or an increased risk of pathogen entry if aseptic access protocols are not strictly followed.
- The choice between a closed- or open-access CVC hub system will depend on the availability of local resources as closed-access systems have a higher cost.
- It was acknowledged that a closed-access system provides additional benefits such as a reduction in needlestick injuries.
- The GDG recognizes that disinfecting the CVC hub before accessing it is a good practice in many healthcare facilities, regardless of whether the hub is open or closed. However, no comprehensive systematic review has been conducted to evaluate the impact of this practice on reducing CLABSI. All IV medications should be prepared in a sterile manner to avoid the risk of contamination.
- Open-access systems require the access caps to be replaced reliably and using a sterile technique.
- GDG members agreed that the aseptic technique would be considered adequate to access the CVC for the routine administration of medications using a closed-access system.