Guidelines for the prevention of intravascular catheter-related infections

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Introduction

In the United States, 15 million central vascular catheter (CVC) days (i.e, the total number of days of exposure to CVCs among all patients in the selected population during the selected time period) occur in intensive care units (ICUs) each year.1 Studies have variously addressed catheter-related bloodstream infections (CRBSI). These infections independently increase hospital costs and length of stay,2, 3, 4, 5 but have not generally been shown to independently increase mortality. While 80,000 CRBSIs occur in ICUs each year,1 a total of 250,000 cases of BSIs have been estimated to occur annually, if entire hospitals are assessed.6 By several analyses, the cost of these infections is substantial, both in terms of morbidity and financial resources expended. To improve patient outcome and to reduce healthcare costs, there is considerable interest by healthcare providers, insurers, regulators, and patient advocates in reducing the incidence of these infections. This effort should be multidisciplinary, involving healthcare professionals who order the insertion and removal of CVCs, those personnel who insert and maintain intravascular catheters, infection control personnel, healthcare managers including the chief executive officer (CEO) and those who allocate resources, and patients who are capable of assisting in the care of their catheters.

The goal of an effective prevention program should be the elimination of CRBSI from all patient-care areas. Although this is challenging, programs have demonstrated success, but sustained elimination requires continued effort. The goal of the measures discussed in this document is to reduce the rate to as low as feasible given the specific patient population being served, the universal presence of microorganisms in the human environment, and the limitations of current strategies and technologies.

Section snippets

Education, training and staffing

  • 1.

    Educate healthcare personnel regarding the indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and appropriate infection control measuresto prevent intravascular catheter-related infections.7, 8, 9, 10, 11, 12, 13, 14, 15 Category IA

  • 2.

    Periodically assess knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of intravascular catheters.7, 8, 9, 10, 11, 12, 13, 14, 15 Category IA

  • 3.

Terminology and estimates of risk

The terminology used to identify different types of catheters is confusing, because many clinicians and researchers use different aspects of the catheter for informal reference. A catheter can be designated by the type of vessel it occupies (e.g., peripheral venous, central venous, or arterial); its intended life span (e.g., temporary or short-term versus permanent or long-term); its site of insertion (e.g., subclavian, femoral, internal jugular, peripheral, and peripherally inserted central

Strategies for prevention of catheter-related infections in adult and pediatric patients

Education, training and staffing

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    Financial support. E.P.D. Grant support through the NIH.

    Potential conflicts of interest. N.P. O'G. served as a board member for the ABIM Subspecialty Board for Critical Care Medicine. M.A. is an employee of the Infusion Nurses Society, Honoraria from 3M, Becton Dickinson, Smiths Medical. L.A.B. is a consultant for Institute of Healthcare Improvement, Board membership for Theradoc, Medline. Honoraria from APIC, Clorox. E.P.D. consulting from Merck, Baxter, Ortho-McNeil, Targanta, Schering-Plough, Optimer, Cadence, Cardinal, BDGeneOhm, WebEx, Cerebrio, and Tyco. Grant support through the NIH. Payment for lecture from Merck. Payment for development of educational presentation from Medscape. Travel and meeting expenses paid for by ASHP, IDSA, ASM, American College of Surgeons, NQF, SHEA/CDC, HHS, Trauma Shock Inflammation and Sepsis Meeting (Munich), University of Minnesota. J.G. Honoria from Ethicon. S.O.H. provides research support from Angiotech; Honoraria from Angiotech, Merck. L.A.M provides research support from Astellas, Theravance, Pfizer; Consulting for Ash Access, Cadence, CorMedix, Catheter Connections, Carefusion, Sage, Bard, Teleflex; Payment for manuscript preparation from Catheter Connections. I.I.R. provides research support from Cubist, Enzon, and Basilea;Consulting for Clorox; Stock Equity or Options in Great Lakes Pharmaceuticalsand Inventive Protocol; Speakers Bureau for Cook, Inc.; Royalty income (patents owned by MD Anderson on which Dr. Raad in an inventor: American Medical Systems, Cook, Inc., Cook urological, Teleflex, TyRx, Medtronic, Biomet, Great Lakes Pharmaceuticals. A.R. consulting income from Eisai Pharmaceuticals, Discovery Laboratories. M.E.R. provides research support from Molnlycke, Cardinal Healthcare Foundation, Sanofi-Pasteur, 3M, and Cubist; Consulting from Semprus; Honorarium for lectures from 3M, Carefusion, Baxter and Becton Dickinson. Previously served on Board of Directors for Society for Healthcare Epidemiology of America. All other authors: no conflicts.

    This is a reprinted version of an article that originally appeared in Clinical Infectious Diseases 2011;52(9):e162-93. Doi: 10.1093/cid/cir257.

    The contents of this special supplement were developed completely under the auspices of the Centers for Disease Control and Prevention (CDC). Publication of the CDC “Guidelines for the Prevention of Intravascular Catheter-Related Infections” in American Journal of Infection Control was made possible by an educational grant from CareFusion Corporation.

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