Assessment of a new hub design and the semiquantitative catheter culture method using an in vivo experimental model of catheter sepsis

Segura, M.; Alia, C.; Valverde, J. Luis; Franch, G.; Rodríguez, J M Torres; Sitges‐Serra, Antonio

doi:10.1128/jcm.28.11.2551-2554.1990

Cited by 44 publications

(6 citation statements)

References 8 publications

(3 reference statements)

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“…A new antiseptic hub attachment has been developed to protect the contamination of the hub and the lumen. This model is used by attaching to the hub of the catheter and has been shown in an animal study 69 to prevent catheter colonization. In addition, a clinical study 70 in patients with long-term catheters showed that they decreased the rate of CRBSIs by 4-fold.…”

Section: Aseptic Hub Modelmentioning

confidence: 99%

Intravascular Catheter-Related Infections

Raad¹,

Hanna²

2002

Arch Intern Med

204

116

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Section: Aseptic Hub Modelmentioning

confidence: 99%

Intravascular Catheter-Related Infections

Raad¹,

Hanna²

2002

Arch Intern Med

204

116

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“…Approximately 65% of CRI originate from the skin flora, 30% from the contaminated hub and 5% from other pathways [20][21][22][23][24][25][26][27]. This distribution probably reflects duration of catheterization and type of patient population studied [28].…”

Section: P a T H O G E N E S I S A N D E T I O L O G Ymentioning

confidence: 99%

Catheter-related infections: diagnosis and intravascular treatment

Bouza

Burillo

Muñóz

2002

Clinical Microbiology and Infection

174

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The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria, or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these drawbacks and to assess the presence of tip colonization without withdrawal. Comparative quantitative blood cultures with a marked increase (> or = 5) in colony counts between blood obtained from the catheter lumen and from a peripheral vein simultaneously is one of those methods. It has a high sensitivity (>80%) and specificity (94-100%) but it is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization. 'Superficial cultures' comprise the semiquantitative culture of the hub, of the skin surrounding the catheter entrance and of the first subcutaneous portion (1 cm) of the catheter after swabbing. The sensitivity of this method is >90%, specificity is >80%, and positive and negative predictive values for catheters (considering together those with and without clinical data of infection) are 66 and 97%, respectively. Endoluminal brushing has proved to be an impractical and unreliable procedure, at least in our experience. New methods based on the speed of bacterial growth to detectable levels of micro-organisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections. Moreover, as the use of antimicrobial-coated catheters becomes more prevalent, the existing definitions of catheter colonization and catheter-related infection may need to be modified, because such coatings may lead to false-negative culture results. Many catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called 'antibiotic lock-in technique', which consists in 'locking' the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

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“…[ 100 ] Catheter associated infections are a significant safety issue, and contamination caused by lack of aseptic technique is preventable. Once contamination occurs, bacteria attach to the inner lumen of the catheter, begin to grow and form biofilm, making successful eradication extremely difficult [ 6 , 28 – 30 , 113 , 127 , 133 , 140 – 142 , 144 , 195 ]. Joint Commission now requires hospitals in the USA to protect patients by having a standard and measurable protocol for hub/access site disinfection [ 61 , 62 , 196 ].…”

Section: Resultsmentioning

confidence: 99%

Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

Moureau

Flynn

2015

Nursing Research and Practice

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Background. Needleless connectors (NC) are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33–45% contaminated, and compliance with disinfection as low as 10%. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5–60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48–86% reduction). Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection.

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Assessment of a new hub design and the semiquantitative catheter culture method using an in vivo experimental model of catheter sepsis

Cited by 44 publications

References 8 publications

Intravascular Catheter-Related Infections

Intravascular Catheter-Related Infections

Catheter-related infections: diagnosis and intravascular treatment

Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

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