Reducing infections associated with central venous catheters

Abstract

The cost of infections in central venous catheters (CVCs) is high both to the NHS and to the patients and their carers. This article discusses reduction of infection in patients with CVCs. Adding to the debate on how to do this, three interlinked factors are discussed: (1) the virulence of the invading micro-organisms, (2) the environment for microbial growth, and (3) the host defence mechanisms. The article encourages healthcare workers to use interprofessional groups to write, update frequently, and discuss protocols designed to reduce infections. The discussion and updating of the protocols, based on local experience, monitoring actions and infection rates within the interprofessional group, will assist in the reduction of infection.

An Observational Study of Peripherally Inserted Central Cather(PICC)-Related Complications Amongst Oncology Patients

“…There is also a significant personal cost for the individual and their family, for example, by loss of earnings and travel costs. Rickard (2003) also describes the human cost, such as stress and anxiety which is difficult to quantify. Alongside these considerations, any mortality has huge personal and economic impacts on families and societies (Pittet et al, 1994).…”

“…Once this cutaneous barrier is broken at PICC insertion however, normal skin organisms such as Staphylococcus aureus and S. epidermis (Maki, Bennett, & Bractiman, 1992) can cross the skin barrier into the catheter and/or bloodstream. There is now strong evidence that normal skin flora at the PICC insertion site are a major risk factor for the development of CRS (Rickard, 2003). Therefore, disinfection of the skin prior to PICC insertion and during follow-up care is a very important infection prevention strategy.…”

“…These microbes may also be free to move about unattached to the biofilm (free living) (Mack, 1999). Once the microbes are attached within the biofilm, because they grow at such a slow rate, they are difficult to remove and are impervious to the body's own immune systems, such as macrophages and other phagocytes (Rickard, 2003). Thus they can live using the surrounding nutrients without hindrance from the immune system or antibiotic therapy.…”

“…There is no one likely reason for the infections, each occurring in similar oncology cohorts but with different microorganisms, when microorganisms were known. The population, by the nature of often being on chemotherapy is at risk of infection (Rickard, 2003).…”