Most infection prevention programs focus on central line insertion, and for good reason. CLABSIs remain one of the deadliest hospital-acquired infections in the US, with mortality rates between 12 and 25 percent.
But central line insertion is not the only moment where sterile technique fails. It is just the one with a name, a bundle, and a regulatory framework behind it.
The procedures nobody watches
ICU nurses perform dozens of bedside procedures every shift that require sterile or clean technique. Dressing changes, catheter insertions, wound care, port access, arterial line draws. All of them carry contamination risk. All of them depend on the same fundamentals (hand hygiene, barrier precautions, field integrity) that break down when census is high and staff is stretched.
The difference is observation. A central line insertion gets audited. A 2 AM dressing change does not.
What the data shows
A 2019 study in the American Journal of Infection Control found hand hygiene compliance before wound care procedures averaged 61 percent. During audited central line insertions, it was 83 percent. Same clinicians, same hands, same soap dispenser on the wall. The gap is not training. It is whether anyone is there to see it.
This pattern shows up in every direct observation study we have read: compliance drops during off-hours, during high-census periods, and during emergencies. These are also the conditions where observation is least likely to happen. The correlation is not subtle.
From CLABSI to broader sterility monitoring
We are expanding our computer vision system beyond central line protocols. The same cameras and edge hardware that track insertion technique can monitor any bedside procedure where sterile field integrity matters.
The hard part is not the hardware. It is training the AI to recognize what a sterile field looks like for a dressing change versus a central line insertion versus an arterial draw. Each procedure has its own steps, its own common failure modes. We are building this now, starting with the procedures where contamination risk is highest and observation rates are lowest.
What this looks like
A nurse performing a wound dressing change at 3 AM gets the same protocol monitoring as a central line insertion during morning rounds. Not because someone scheduled an audit. Because the system does not have shift changes.
No additional cameras. No additional hardware. The same on-premise infrastructure that handles CLABSI prevention covers sterility breaches across other ICU procedures.
The observation gap in ICUs is a capacity problem. Clinicians know the protocols. They just cannot be watched around the clock by other humans. Cameras can.