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 working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996. These guidelines are intended to provide evidence-based 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 (ie, 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.

Avaliação do tipo de curativo utilizado em cateter venoso central para hemodiálise

“…Prevention of venous catheter-related infections involves measures related with their implementation, handling, and maintenance. Several authors suggest the following preventive measures: use of tunneled catheters with a cuff, correct handling in catheter insertion and maintenance, periodical training of the nursing staff, use of standard precautions, use of chlorhexidine as antiseptic, use of antibiotic ointments in the insertion site, use of antibiotic solutions in the catheter closure, use of citrate; application of mupirocin nasal, careful assessment of the dressing and exit site of the catheter are measures that can significantly decrease the incidence of infection (6,13,(20)(21)(22) . The use of transparent film dressing was satisfactorily accepted by part of the patients, especially because of the possibility of a better hygiene without running the risk of wetting the insertion site.…”

Catheter-related bloodstream infections: catheter management according to pathogen

“…Although the incidence of infection associated with peripheral venous catheters is usually low, serious infectious complications produce considerable annual morbidity because of the frequency with which such catheters are used [7]. However, most Short-term catheters (<14 days) are the most commonly used CVCs and account for most CRBSIs.…”

“…The microbes that colonize catheter hubs and the skin surrounding the insertion site are the source of most CRBSIs [6][7][8]. Migration of skin organisms from the insertion site into the cutaneous catheter tract, with colonization of the catheter tip, is the most common route of infection for peripherally inserted short-term catheters [21,22].…”

Contamination of Guidewires During Insertion of Central Venous Catheters in an Intensive Care Setting

“…1 During difficult insertion, multiple manipulations of the equipment occur and the drapes often move, potentially exposing areas of skin that have not been appropriately cleansed.…”