Guideline for Prevention of Intravascular-Device–Related Infections

Abstract

The “Guideline for Prevention of Intravascular Device-Related Infections” is designed to reduce the incidence of intravascular device-related infections by providing an over view of the evidence for recommendations considered prudent by consensus of Hospital Infection Control Practices Advisor y Committee (HICPAC) members. This two-part document updates and replaces the previously published Centers for Disease Control's (CDC) Guideline for Intravascular Infections (Am J Infect Control 1983;11:183-199). Part I, “Intravascular Device-Related Infections: An Over view” discusses many of the issues and controversies in intravascular-device use and maintenance. These issues include definitions and diagnosis of catheter-related infection, appropriate barrier precautions during catheter insertion, inter vals for replacement of catheters, intravenous (IV) fluids and administration sets, catheter-site care, the role of specialized IV personnel, and the use of prophylactic antimi-crobials, flush solutions, and anticoagulants. Part II, “Recommendations for Prevention of Intravascular Device-Related Infections” provides consensus recommendations of the HICPAC for the prevention and control of intravascular device-related infections. A working draft of this document also was reviewed by experts in hospital infection control, internal medicine, pediatrics, and intravenous therapy. However, all recommendations contained in the guideline may not reflect the opinion of all reviewers.

Hospital-Acquired, Laboratory-Confirmed Bloodstream Infection: Increased Hospital Stay and Direct Costs

“…17,18,21 The aim of our study was to estimate the overall increased hospital stay and costs attributable to hospitalacquired, laboratory-confirmed BSIs. Consequently, in the results, we did not distinguish whether these were catheter related.…”

“…The overall incidence and pathogen-specific rates of hospital-acquired, laboratory-confirmed BSI were similar to those observed in large teaching hospitals elsewhere. 21,[24][25][26] The method used to select patients for the study was designed not to estimate the incidence of hospital-acquired, laboratory-confirmed BSI, but rather to obtain a representative sample of adult cases of hospital-acquired, laboratory-confirmed BSI in a busy teaching hospital. It is possible that some cases were undiagnosed or were treated or died before diagnosis.…”

“…Catheter-related, laboratory-confirmed BSI was defined as above plus the isolation of the same microorganism from a semiquantitative culture from a central venous catheter and a peripheral blood sample. 21 Any patient who had laboratory-confirmed BSI 48 hours or more after admission to the ward was included. Primary BSI referred to that for which there was no other documented site of infection other than catheter-related BSI.…”

A Convenient Way to Avoid Venipuncture and Finger Contamination

“…1 This is hazardous for patients, especially if the phlebotomist does not hand wash and scrub fingernails before gloving 2 and uses an unsterile gloved finger of the nondominant hand to guide the needle accurately into a selected vein after sterile preparation of the venipuncture site. 24 A safer way to avoid venipuncture contamination and protect phlebotomists from touching blood during IV access procedures might be outlined as follows:…”

COSMOS Study Microbiological Results: Bacterial Colonization and Infection of Long-Term Peripheral Catheters

“…They are the cause of considerable morbidity and mortality, prolonged hospital stays and an increased cost [16,17] of up to € 3,700 per episode [2].…”