Overview of catheter-related infections with special emphasis on prevention based on educational programs

Abstract

Intra-vascular access is an unavoidable tool in sophisticated modern medical practice, and catheter-related infection remains a leading cause of nosocomial infections, particularly in intensive care units where it is associated with significant patient morbidity, mortality, and additional hospital costs. The incidence of catheter-related bloodstream infection ranges from 2 to 14 episodes per 1000 catheter-days. On average, microbiologically documented, device-related bloodstream infections complicate the use of a central venous line in three to five per 100 cases. But this represents only the visible part of the iceberg and most episodes of clinical sepsis are nowadays considered to be catheter-related. We briefly review the pathophysiology of these infections, highlighting the importance of the skin insertion site and the intravenous line hub as principal sources of colonization and infection. Principles of therapy are briefly addressed. A large proportion of these infections are preventable and this has been the objective of creating precise guidelines. It was recently suggested that the situation may evolve with the introduction of antibiotic/antiseptic-coated devices, whose impact on the epidemiology of antibiotic resistance remains to be determined. Recently, educational programs and/or a global preventive strategy based on the strict application of specific preventive measures and careful control of all factors associated with infection proved to be even more effective than coated devices in reducing rates of infection. Practical aspects regarding educational approaches will help clinicians to adapt and incorporate educational programs into clinical practice.

Etiology and pathogenesis of bloodstream infections associated with the use of long-term central vascular catheter (CVC) in patients who undergone gastrointestinal surgery

“…Catheter tip colonization: absence of infection signs at the catheter insertion site and microorganisms growth ≥ 10 3 UFC/ mL (by quantitative culture) or ≥ 15 UFC/ mL (by semiquantitative culture) [9].…”

“…www.bjid.com.br Catheter associated infection: positive hemoculture with the same microorganism which is present on the catheter tip (by either quantitative or semi-quantitative culture) and clinical and microbiological absence of any other source of infection [9].…”

Staphylococcus aureus Infections in Injection Drug Users: Risk Factors and Prevention Strategies

“…12% of all nosocomial infections reported in a study on more than 10,000 European intensive care patients) [24], and are associated with significant attributable mortality (4 to 30%) and costs (USD 4,000 to USD 40,000) [25]. More than 85% of primary nosocomial bacteremias are intravascular catheterrelated [25] and it has been shown that the mortality rate attributed to catheter-related S. aureus bacteremia (8.2%) significantly exceeds the rates for other pathogens [26]. These aspects are particularly relevant to hospitalized IDUs, because most of them need a vascular access, frequently a central venous catheter, since peripheral line insertion and even blood drawings are often difficult or impossible in IDUs.…”

“…Several preventive measures regarding skin disinfection, sterile insertion, dressing, handling and replacement of the catheter have been shown to reduce the incidence of CRBSI and have been recommended [25,28].As a result of the implementation of these measures, during the last 10 years the incidence of intravascular device-associated bloodstream infections has decreased in the United States by nearly 40% [29]. Educational programs also proved to be very effective in reducing rates of CRBSI [30,31].…”

Risk Factors for Bacteremia and Predictors of Mortality of Patients with Bloodstream Infection with Methicillin-Resistant Staphylococcus aureus

“…The condition shows high frequency, representing for instance 12% of all nosocomial infections in an European study involving over 10,000 Intensive Care Unit (ICU) patients [4] . It is also related to significant mortality rates (4a 30%) [5] .…”