Skin colonisation at the catheter exit site is strongly associated with catheter colonisation and catheter‐related sepsis

Ponnusamy, Vennila; Perperoglou, Aris; Venkatesh, Vidheya; Curley, Anna; Brown, Nicholas M.; Tremlett, Catherine; Clarke, Paul

doi:10.1111/apa.12779

Cited by 13 publications

(16 citation statements)

References 17 publications

(31 reference statements)

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“…Skin colonization is a very important risk and surrogate factor for CRBSI [2, 6]. Therefore, the results suggest that the use of octenidine-based disinfectants may decrease CRBSI risk in CVC and EC patients significantly [6, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the results suggest that the use of octenidine-based disinfectants may decrease CRBSI risk in CVC and EC patients significantly [6, 13]. …”

Section: Discussionmentioning

confidence: 99%

“…As the amount of skin colonization is directly associated with catheter colonization and therefore with CRBSI risk, it is essential to focus on continuous skin hygiene [6]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial

Lutz¹,

Diener²,

Freiberg³

et al. 2016

Infection

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PurposeCatheter-related bloodstream infections affect patients in surgical and intensive care settings worldwide, causing complications, aggravation of existing symptoms and increased length of stay. The trial aimed at comparing two registered skin antiseptics with respect to their residual and therefore infection-preventing effects.MethodsIn a parallel, monocentric, prospective, triple-blind, randomized trial the difference in bacterial recolonization of catheter skin sites in central venous (CVC) and epidural catheters (EC) was investigated by comparing two alcoholic-based skin disinfectants. Patients receiving planned surgeries or intensive care were eligible for the trial. Those in the trial group received skin disinfection with the additive octenidine dihydrochloride (OCT) (n = 51), those in the control group were treated with benzalkonium chloride as additive (BAC) (n = 59) prior to catheter insertion. Randomization was carried out by assigning patients to groups week-wise. Endpoints of the investigation were skin colonization of the catheter site counted in colony forming units per swab at three time points: (1) prior to catheter insertion, on untreated skin; (2) directly after catheter insertion, prior to sterile coverage; (3) 48 h after catheter insertion. The hypothesis was tested by a Wilcoxon test with a two-sided alpha = 5 %.ResultsFrom second to third swab, recolonization of the catheter-surrounding skin was significantly lower in the trial group for both sorts of catheters: delta 2–3 OCT group: 0.72 (95 % CI: 0.42; 1.02); delta 2–3 BAC group: 1.97 (95 % CI: 1.45; 2.50); p < 0.001. None of the patients enrolled developed a catheter-related blood stream infection (CRBSI) during follow-up.ConclusionsPrevious studies have shown that skin colonization is strongly associated with the occurrence of CRBSI. This randomized controlled trial supports the observations made in previous trials that octenidine dihydrochloride in disinfectants is more effective than agents containing other additives with regard to skin recolonization surrounding CVC and EC insertion sites. Therefore, it is likely to also reduce the risk of CRBSI in these patient groups. The trial was approved by the North Rhine Medical Association in July 2014 (application-no.: 2014222).

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the results suggest that the use of octenidine-based disinfectants may decrease CRBSI risk in CVC and EC patients significantly [6, 13]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial

Lutz¹,

Diener²,

Freiberg³

et al. 2016

Infection

View full text Add to dashboard Cite

show abstract

“…Nevertheless the recovery of DNA from both skin and PIVC tip, with a different bacterial composition to that observed in other studies, suggests that some viable bacteria remained after treatment, or that PIVC insertion site was recolonised after some point after catheter insertion. Viable bacteria may remain in hair follicles and the lower dermis and thus may be shielded from antiseptics [ 34 ]. In our case, the culture of bacteria from skin at PIVC insertion sites indicates that some viable organisms were present at the insertion site at time of catheter removal.…”

Section: Discussionmentioning

confidence: 99%

Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs

et al. 2016

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Skin bacteria at peripheral intravenous catheter (PIVC) insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs). Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, p<0.001). Methylobacterium spp. was the dominant genus in all PIVC tip samples, but not so for skin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%), Pseudomonas spp., (10%) and Acinetobacter spp. (10%) were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

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“…[ 3 – 5 ] Pathogens colonising the skin enter the bloodstream during CVC insertion or through migration along the catheter surface after insertion. [ 6 – 8 ] In addition, pathogens may be introduced into the blood stream when the CVC connection is breached to administer medication or fluids. [ 7 , 9 ] Neonates have an elevated risk of BSI compared with older children and adults due to their immunological immaturity, thinner and more permeable skin, exposure to frequent invasive procedures and reliance on parenteral nutrition.…”

Section: Introductionmentioning

confidence: 99%

Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales

et al. 2018

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BackgroundThere is uncertainty about the variation in infection prevention practices for central venous catheters (CVC) in neonatal units (NNUs) and how practices relate to national guidance.AimTo evaluate evidence supporting infection prevention practices for CVCs recommended in national guidelines and to compare with reported practices for peripherally inserted central catheters (PICC), a type of CVC widely used in NNUs.DesignWe searched national guidelines for neonates and children to identify infection prevention practices for CVCs and conducted an overview of studies to determine the quality of evidence underpinning recommendations. We surveyed 134 NNUs in England and Wales to ascertain reported practice.ResultsWe found low quality evidence supporting CVC care bundles and use of 2% alcoholic chlorhexidine to decontaminate catheter ports and skin before insertion. Moderate quality evidence supported recommendations against routinely replacing CVCs and against chlorhexidine-impregnated dressings. 90% (44/49) of NICUs and 40% (34/85) of LNUs responded. 66% (48/73) of NNUs reported using CVC care bundles for insertion; 62% (45/73) used bundles for maintenance. 63% (32/51) of those using bundles reported monitoring adherence. 85% (61/72) of NNUs did not routinely replace PICCs and 89% (63/71) did not use chlorhexidine-impregnated dressings. Antiseptic use varied with alcoholic 2% chlorhexidine used for skin preparation in 33% (23/71) of NNUs and for catheter ports in 52% (37/71).ConclusionsLack of consistency across NNUs in antiseptic use and low rates of reported CVC care bundle use may reflect the low quality of evidence of the effectiveness and safety of these interventions in NNUs. Clinical trials are needed to quantify benefits and harms of infection prevention practices in NNUs.

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Skin colonisation at the catheter exit site is strongly associated with catheter colonisation and catheter‐related sepsis

Cited by 13 publications

References 17 publications

Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial

Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial

Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs

Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales

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