Catheter-related infections prevention

Lines and eatheters Catheter-related infection prevention... 

Treatment Exit-site infections may be treated immediately with empiric coverage, or treatment may be delayed until cultures return. Empiric treatment of catheter-related infections should cover S. aureus. Coverage for P. aeruginosa should also be included if the patient has a history of infections with this organism.49 Cultures and sensitivity testing are particularly important in tailoring antibiotic therapy for catheter-related infections to ensure eradication of the organism and prevent recurrence or related peritonitis. 

Prevention of peritonitis and catheter-related infections starts when the catheter is placed. The exit site should be properly cared for until it is well healed before it can be used for PD. Patients should receive proper instructions for care of the catheter during this time period, which can last up to 2 weeks. Patients should also be instructed on the proper techniques to use for dialysate exchanges to minimize the risk of infections during exchanges, which is the most common cause of peritonitis. 

Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomy-cin/ciprofloxacin/heparin flush solution A randomized, multicenter, double-bhnd trial. J Qin Oncol 2000 18(6) 1269-78. 

Sheng WH, Ko WJ, Wang JT, Chang SC, Hsueh PR, Luh KT. Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients. Diagn Microbiol Infect... 

O Grady N P, Alexander M, Dellinger E P et al 2002 Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 110 e51... 

Patients who experience fever during HD should immediately have blood cultures obtained. If a temporary catheter is being used, it should be removed and the tip of the catheter cultured. Commonly used preventive approaches to catheter-related infections include minimizing use and duration of catheters, proper disinfection and sterile technique, and use of exit-site mupirocin or povidone-iodine ointment. Adoption of strict unit protocols that employ universal pre-... 

Attempts to prevent peritonitis and catheter-related infections... 

Reportedly, a bland soap handwash was ineffective in preventing transfer by hand of gram-negative bacteria to catheters following brief contact with a heavily contaminated patient source an alcohol hand rinse was generally effective. Other studies have compared the effectiveness of 10% povidone-iodine, 70% isopropanol, and 2% aqueous CHG for the prevention of infection associated with central venous and arterial catheters [5]. CHG resulted in the lowest incidence of local catheter-related infection (2.3% vs. 7.1% and 9.3% for isopropanol and povidone-iodine, respectively) and catheter-related bacteremia (0.5% vs. 2.3% and 2.6% for isopropanol and povidone-iodine, respectively [5]. 

Guggenbichler JP, Samuel U. 2004. Prevention of catheter-related infections The potential of a new nano-silver impregnated catheter. Int J Antimicrob Agents 23 S15-S7S. 

Raad, I., Hanna, H., and Maki, D. 2007. Intravascular catheter-related infections Advances in diagnosis, prevention, and management. Lancet Infect Dis. 1 645-657. 

Use of antibiotic impregnated central venous catheters to prevent catheter related infections. 

Bloodstream Infection Guideline for the Prevention of Intravascular Catheter-Related Infections (2011)... 

Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000 132 391 02. 

Marconi W, Francolini 1, Piozzi A, Rosa RD. Antibiotic releasing urethane polymers for prevention of catheter related infections. J Bioact Compat Polym 2001 16 393-407. http //dx.doi.org/10.1106/g5eb-1173-k59a-7ybf. 

Catheter material can play an important role in the prevention of catheter-related infections (CR-Is). Indeed, more infectious complications have been associated with the use of polyvinyl chloride (PVC) or polyethylene catheters compared to catheters made of Teflon or polyurethane (PU). 

O Grady NP, Alexander M, Bums LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control May 2011 39(4 Suppl. l) Sl-34. Francolini 1, Donelli G. Prevention and control of biofilm-based medical-device-related infections. FEMS Immunol Med Microbiol August 2010 59(3) 227-38. 

Donelli G, Francolini I. Efficacy of antiadhesive, antibiotic and antiseptic coatings in preventing catheter-related infections review. J Chemother December 2001 13(6) 595-606. 

Bach A. Clinical studies on the use of antibiotic- and antiseptic-bonded catheters to prevent catheter-related infection. Zentralbl Bakteriol December 1995 283(2) 208-14. Greenfeld JI, Sampath L, Popilskis SJ, et al. Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Crit Care Med May 1995 23(5) 894-900. 

Brun-Buisson C, Doyon F, Sollet JP, et al. Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters a randomized controlled trial. Intensive Care Med May 2004 30(5) 837 3. 

Francais A, Adrie C, Zahar JR, Thuong M, Arrault X, Croize J, Lucet JC. Chlorhexidine impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill patients. JAMA 2009 301(12) 1231 1. 

Published guidelines on the management of catheter-related infections are in favor of the use of ALT for the treatment of catheter-related infections [24]. The in vitro stability of antibiotic-heparin combinations in CVCs was studied by Vercaigne et al. [25]. While ciprofloxacin produced immediate precipitation with heparin, cefazolin, vancomycin and ceftazidime at 10 mg/ml and gentamycin at 5 mg/ml were successfully incubated with heparin (5,000 U/ml) for 72 h in the central venous catheter lumen. Although free antibiotic in CVC solution was reduced, the final concentration was still sufficient for an effective antibiotic-heparin lock [25]. Good evidence is available to support ALT in the prevention of catheter-related bacteremia in patients on hemodialysis [26,27]. However, others have reported that the use of ALT may be limited due to antibiotic toxicity and the appearance of antibiotic-resistant microbial isolates [28, 29]. 

Fong IW Prevention of haemodialysis and peritoneal dialysis catheter related infection by topical povidone-iodine. Postgrad Med J 1993 69(suppl 3) S15-S17. 

Dogra GK, Herson H, Hutchison B Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filhng with gentamicin and citrate a randomized controlled study. J Am Soc Nephrol 2002 13 2133-2139. 

Chatzinikolaou I, et ah Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter-related infections a prospective, randomized study. Am J Med 2003 115 352-357. 

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