Guidelines for the prevention of intravascular catheter-related infections

Abstract

These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The These guidelines are intended to provide evidencebased recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

Infection control guidelines for the cardiac catheterization laboratory: Society guidelines revisited

“…A 2% chlorhexidine-based preparation (e.g., Chloraprep) for skin antisepsis is preferred during central line insertion, but tincture of iodine (an iodophor) or 70% alcohol may be substituted [9].…”

“…Povidine iodine is most effective when allowed to remain on the skin for at least 2 min or longer if it is not yet dry [9].…”

“…Use aseptic technique, including the use of a cap, mask, sterile gown, sterile gloves, and a large sterile sheet, for the insertion of central venous catheters (including peripherally inserted central catheter (PICCs)) or guidewire exchange [9].…”

“…Use either a sterile gauze or sterile and transparent semipermeable dressing to cover the catheter site. Do not use nonpermeable (plastic) dressings [9].…”

“…In 2003, the AHA published a scientific statement regarding nonvalvular cardiovascular device-related infection [2]. In 2002, the Centers for Disease Control (CDC) published guidelines for prevention of intravascular catheterrelated infections, which are now considered the best clinical practice guidelines [9]. Other recent guidelines, including those on the prevention of surgical site infection [10], hand hygiene in healthcare settings [11], and environmental infection control in healthcare facilities [12], contain recommendations relevant to the cardiac catheterization laboratory.…”