Guidelines for the prevention of intravascular catheter-related infections
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
References (370)
- et al.
The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies
Mayo Clin Proc
(2006) - et al.
The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU
Chest
(2004) - et al.
Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care
Lancet
(2000) - et al.
Complications of intravenous therapy with steel needles and Teflon catheters. A comparative study
Am J Med
(1981) Peripheral access options
Surg Oncol Clin N Am
(1995)- et al.
Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia
J Hosp Infect
(2005) - et al.
To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization?
J Infect Chemother
(2006) - et al.
Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients
Chest
(2000) - et al.
Central catheter infections: single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters
Am J Med
(1988) - et al.
Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters
Lancet
(1991)
A randomized trial comparing Arglaes (a transparent dressing containing silver ions) to Tegaderm (a transparent polyurethane dressing) for dressing peripheral arterial catheters and central vascular catheters
Intensive Crit Care Nurs
Mupirocin resistance in coagulase-negative staphylococci, after topical prophylaxis for the reduction of colonization of central venous catheters
J Hosp Infect
Swimming and central venous catheter-related infections in the child with cancer
J Pediatr Oncol Nurs
Surveillance of infection in home care
Am J Infect Control
Prevention of intravascular catheter-related infections
(Erratum: Ann Intern Med 133:395, 2000). Ann Intern Med
Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit
Arch Surg
Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital
Crit Care Med
Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections
Clin Infect Dis
Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients
Am J Respir Crit Care Med
Effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea
Infect Control Hosp Epidemiol
An educational intervention to prevent catheter-associated bloodstream infections in a non-teeaching community medical center
Crit Care Med
A multicenter intervention to prevent catheter-associated bloodstream infections
Infect Control Hosp Epidemiol
The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico
Crit Care Med
Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit
Crit Care Med
The impact of bedside behavior on catheter-related bacteremia in the intensive care unit
Arch Surg
Education of physicians-in-training can decrease the risk for vascular catheter infection
Ann Intern Med
Nutritional support of the hospitalized patient. The team concept
JAMA
Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial
Arch Intern Med
Intravenous therapy team and peripheral venous catheter-associated complications. A prospective controlled study
Arch Intern Med
The impact of an i.v. team on the occurrence of intravenous-related phlebitis. A 30-month study
J Intraven Nurs
The infusion nurse and patient complication rates of peripheral-short catheters. A prospective evaluation
J Intraven Nurs
Reduction in nosocomial intravenous device-related bacteremias after institution of an intravenous therapy team
J Intraven Nurs
Development of a Vascular Access Team in an acute care setting
J Infus Nurs
A proactive approach to combating venous depletion in the hospital setting
J Infus Nurs
Impact of a dedicated infusion therapy team on the reduction of catheter-related nosocomial infections
J Infus Nurs
An infusion program resource nurse consult service: our experience in a major Canadian teaching hospital
J Infus Nurs
A nursing process model: quantifying infusion therapy resource consumption
J Infus Nurs
The i.v. therapy team: impact on patient care and costs of hospitalization
NITA
Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
JAMA
Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units
Infect Control Hosp Epidemiol
The role of understaffing in central venous catheter-associated bloodstream infections
Infect Control Hosp Epidemiol
The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit
Infect Control Hosp Epidemiol
Infection control in intravenous therapy
Ann Intern Med
Steel needles used for intravenous therapy. Morbidity in patients with hematologic malignancy
Arch Intern Med
Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial
Ann Intern Med
The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping
Am J Med
Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial
JAMA
Complications of central venous catheters: internal jugular versus subclavian access–a systematic review
Crit Care Med
Comparison between the jugular and subclavian vein as insertion site for central venous catheters: microbiological aspects and risk factors for colonization and infection
Braz J Infect Dis
Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia
Arch Intern Med
Cited by (0)
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.