Venous Catheter-Related Bloodstream Infections

Central Venous Catheter-Related Bloodstream Infections 

Employ maximal sterile barrier precautions. Use aseptic techniques including the use of a cap, mask, sterile gown, sterile gloves, and a large sterile sheet for the insertion of all central venous catheters (CVCs). Use 2% chlorhexidine gluconate solution for skin sterilization at the CVC insertion site. Avoid the femoral site for nonemergency CVC insertion and ensure prompt removal of unnecessary catheters. 

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Maki, D. G., Stolz, S. M., Wheeler, S., and Mermel, L. A., Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial, Ann. Intern. Med., 1997 127(4) 257-266. 

Central Venous Catheter-Related Bloodstream Infections... 

Parenteral nutrition was a susceptibility factor for central venous catheter-related bloodstream infections in 109 patients who received chemotherapy after surgery for colorectal cancer for a total of 5558 catheter-days in a retrospective database evaluation (OR = 13 95% Cl = 2.5, 62). 

According to the CDC, almost 1.7 million hospital-acquired infections (HAIs) occur yearly, contributing to approximately 99,000 deaths. Such infections were long accepted by clinicians as an inevitable hazard. Recent efforts demonstrate that simple measures can prevent the majority of common infections. Hospitals and providers must work to reduce the burden of these infections. Four specific infections account for more than 80 percent of all hospital-related infections. They are surgical site infections, catheter-associated urinary tract infections, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia. Preventing the transmission of antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) remains an important infection control priority. Effective measures exist to prevent the most common healthcare-related infections. 

Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA 1999 282(6) 554-60. 

Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneoulsy inserted, non-cuffed central venous catheters Implications for preventive strategies. Medicine 2002 86 466-479. 

Infection risk Catheter-related bloodstream infections pose a significant problem for hospitalized patients. In a randomized comparison in 960 patients of 5-fiuoruracil or chlorhexidine-I-silver sulfadiazine as central venous catheter coatings, 5-fluorouracil was non-inferior to chlorhexidine-b silver sulfadiazine with respect to the incidence of catheter colonization (2.9% versus 5.3%) [ll ]. Local site infections occurred in 1.4% with 5-fluoruracil and 0.9% with chlorhexidine + silver sulfadiazine. There were no episodes of catheter-related bloodstream infections with 5-fluoruracil but two episodes with chlorhexidine + silver sulfadiazine. The incidence of adverse events was low and comparable in the two groups. 

Abdelkefi A, Achonr W, Ben Othman T, Ladeb S, Toijman L, Lakhal A, et al. Use of heparin-coated central venous lines to prevent catheter-related bloodstream infection. J Support Oncol 2007 5 273-8. 

Bong JJ, Kite P, Wilco MH, et al. Prevention of catheter related bloodstream infection by silver iontophoretic central venous catheters a randomised controlled trial. J Clin Pathol October 2003 56(10) 731-5. 

Ranucci M, Isgro G, Giomarelli PP, et al. Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection. Crit Care Med January 2003 31(l) 52-9. 

Central Venous Catheters Central venous catheters (CVCs) are widely used in hospital practice indeed it has been estimated that, in the United States alone, about 5 million of these units are inserted annually [52]. The widespread use of CVCs is associated with potential infective complications, with the annual incidence of catheter-related bloodstream infection estimated at around 80000 cases in the US [53, 54]. 

Hemodialysis (HD) catheter-associated bloodstream infections (BSls) are a type of CLABSI due to a central venous catheter (CVC) specifically designed for HD. In 2002, it was estimated that 50,000 CLABSIs occur in dialysis patients in the US annually. A more recent surveillance study found the rate of access-related BSIs to be 0.73 events per 100 patient-months [5]. Aside from catheters, patients in need of renal replacement therapy should eventually use arteriovenous fistula (AVF) or arteriovenous grafts (AVG) for HD, or alternatively, may receive peritoneal dialysis. All renal replacement therapies are associated with a risk of infection however, this risk varies with the method selected. Data from a CDC surveillance program display nicely how the type of access influences the BSI rate per 100 patient-months 0.5 (for AVFs), 0.9 (AVG), 4.2 (permanent CVCs), and an impressive 27.1 for temporary CVCs [6]. Another, more practi-... 

Raad, 1.1., Darouiche, R. O., Dupuis, J., Abi-Said, D., Gabrielli, A., Hachem, R., Wall, M., Harris, R., Jones, J., Buzaid, A., et al., Central venous catheters coated with minocycline and rifampin for the pevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. The Texas Medical Center Catheter Study Group, Ann. Intern. Med., 1997 127(4) 267-274. 

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