CLABSI risk stratification

WATCH Score

A five-item bedside tool that predicts the risk of central line-associated bloodstream infection (CLABSI) in hemodialysis patients with a central dialysis catheter.

WWhite blood cell count
AAnemia
TTachycardia
CComorbid diabetes
HHigh BMI
Laboratory
×10³/µL
Enter using a decimal point, e.g. 9.20
Vital sign
bpm
Resting heart rate at assessment
Comorbidities
Body measurements
kg
cm
Body mass index (calculated automatically)
WATCH score
W A T C H
/ 5
Enter all values

Complete every field on the left to calculate the score.

CriterionValueThresholdPoint
WBC count > 10.58 ·
Anemia present ·
Heart rate > 84.5 ·
Diabetes mellitus present ·
BMI (calculated) > 22.59 ·

Suggested actions

Results will appear once the score is calculated.
  • Fill in all fields to see tailored, easy-to-follow recommendations for this patient.
About

What the WATCH score does

Central venous catheters (CVC) are widely used for hemodialysis vascular access but carry a substantial risk of central line–associated bloodstream infection (CLABSI), a major cause of morbidity, mortality, and healthcare costs. Although current international guidelines recommend a standardized preventive care bundle for all patients with central venous catheters, they do not provide a practical bedside tool for identifying individuals at increased risk who may benefit from intensified preventive measures.

The WATCH score was developed from a retrospective cohort of 250 hemodialysis patients with a central dialysis catheter, of whom 104 (41.6%) developed CLABSI. Five routinely available variables were combined into a simple additive score, where one point is given for each criterion that is met.

WWhite blood cell count above 10.58 ×10³/µL
AAnemia present
TTachycardia — heart rate above 84.5 bpm
CComorbid diabetes mellitus present
HHigh body mass index above 22.59 kg/m²

The resulting score (0–5) places a patient into a low, moderate, or high CLABSI-risk category, each linked to a simple set of suggested actions for catheter care and monitoring.

Validation summary
Patients (derivation cohort)250
CLABSI events104 (41.6%)
Predictors in final model5
Discrimination (AUC)0.718
Calibration (H–L test)p = 0.295
Study designRetrospective cohort
SettingIndonesia, 2023–2025
View the WATCH Score summary figure Full scoring algorithm, risk groups, and clinical interpretation in one diagram
Evidence

Reference & methodology

Selected references Contact the authors
  1. O’Grady NP. Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011). 2011.
  2. Ling ML, Apisarnthanarak A, Ching P, Chen YC, Harrington G, Huh JW, et al. APSIC revised guidelines for prevention of central line associated bloodstream infections (CLABSI): a summary and position statement. Antimicrob Steward Healthc Epidemiol. 2026 Feb 3;6(1):e39. doi:10.1017/ash.2026.10298 PubMed PMID: 41658317; PubMed Central PMCID: PMC12877909.
  3. Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020 Jan;132(1):8–43. doi:10.1097/ALN.0000000000002864 PubMed PMID: 31821240.
  4. Buetti N, Marschall J, Drees M, Fakih MG, Hadaway L, Maragakis LL, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology. 2022 May;43(5):553–69. doi:10.1017/ice.2022.87
  5. World Health Organization, editor. Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: part 1: Peripheral catheters. Geneva: World Health Organization; 2024. 1 p.
  6. Kusek L. Preventing Central Line-Associated Bloodstream Infections. Journal of Nursing Care Quality. 2012 Oct;27(4):283–7. doi:10.1097/NCQ.0b013e31825733d1
This tool is intended to support, not replace, clinical judgment by trained healthcare professionals. It is derived from a single-center retrospective cohort and is pending external, multicenter validation before routine clinical implementation.