What is new for the prevention of catheter-related bloodstream infections?

Lorente, Leonardo

doi:10.21037/atm.2016.03.10

Cited by 10 publications

(8 citation statements)

References 42 publications

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“…It further supports the recommendation that fistula and graft use should be promoted among dialysis patients [12,13]. For those patients unable or unwilling to use a fistula or graft, multiple studies have shown that chlorhexidine use at the catheter vascular access site reduces the incidence of BSIs [12,13,16]. Appropriate use of this antiseptic may also help reduce BSIs in catheterized patients.…”

Section: Discussionsupporting

confidence: 57%

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Ramadan

Hebbar

2018

Med Princ Pract

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Objective: To determine the difference in the rates of dialysis events stratified by vascular access type and to describe the microbiological profile and sensitivity patterns of positive blood cultures over a 3-year period. Subjects and Methods: The dialysis event data of 10,751 chronic hemodialysis patients collected from March 2013 to February 2016 at an outpatient dialysis unit in Kuwait were reviewed. The dialysis events studied were: intravenous (IV) antimicrobial use, a positive blood culture, and signs of inflammation at the vascular access site. Dialysis event rates were stratified by the type of vascular access used for the dialysis, i.e., fistula, graft, and tunneled/nontunneled central line. Rates were expressed per 100 patient-months. Results: The overall dialysis event rate was (10.7/100 patient-months). The rate of IV antimicrobial use was higher (12.53/100 patient-months) in patients with tunneled central lines than in all other vascular access types (10.29/100 patient-months). Positive blood culture and inflammation at the vascular access site were highest in patients with nontunneled central lines (1.65 and 1.54/100 patient-months, respectively) when compared to those with other types of vascular access. Gram-negative rod isolates were predominant in patients with central lines (n = 35; 46.67%); however, common skin commensals and gram-negative rods were also identified in patients with fistula or graft (n = 4; 44.45%). Conclusion: Dialysis event rates were higher among patients with tunneled or nontunneled central lines than in patients with fistula or graft. Gram-negative rods were the most commonly isolated microbial group.

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Section: Discussionsupporting

confidence: 57%

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Ramadan

Hebbar

2018

Med Princ Pract

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“…Only one high-powered European randomised controlled trial [26] evaluated the efficacy of skin disinfection modalities, i.e., four-step disinfection with scrubbing of the skin (detergent, rinsing, drying and disinfection) versus one-step disinfection (only one application of disinfectant on macroscopically clean skin), with two different antiseptics, povidone-iodine/alcohol versus chlorhexidine-alcohol. Cleaning the skin with detergent is one of the French recommendations devised to reduce the number of microorganisms on the skin and improve the efficacy of disinfection [28,29]. Regardless of the antiseptic used, this study showed that this cleansing step in no way decreased the infection, bacteraemia or catheter colonisation rates.…”

Section: Grade 1+ Strong Consensusmentioning

confidence: 71%

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Timsit

Baleine

Bernard

et al. 2020

Ann. Intensive Care

128

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The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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“…The same guidelines recommend the use of CHG- impregnated dressings. 9 CHG suppresses bacterial growth at injection sites and reduces the incidence of CRBSIs. The antimicrobial activity of the CHG dressing is unique among existing dressings.…”

Section: Discussionmentioning

confidence: 99%

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms

et al. 2018

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Objective:We compared the protective effects of secure Chlorhexidine Gluconate (CHG)-containing dressings with those of non-antimicrobial transparent dressings.Methods:This prospective, comparative, single-center clinical study was conducted in a tertiary pediatric intensive care unit from October 2014 to March 2017. The inclusion criterion was catheterization of the jugular vein for ≥48 hour. The study was conducted in two phases. Non-antimicrobial standard dressings were applied both before and after the CHG- dressing phase to negate any coincidental temporal effect. During the standard-dressing phases, the dressings did not include any antimicrobial; transparent CHG-impregnated dressings were applied during the test phase. All patients were divided into two groups by the type of dressing applied (standard and CHG-containing dressings).Results:The standard- and CHG-dressing groups contained 68 and 63 patients, respectively. The median durations of catheterization were 13 (8–22) and 14 (2–28) days, respectively (p>0.05). The Catheter-Related Bloodstream Infection (CRBSI) rate was somewhat lower in the CHG-dressing group (20.6 vs. 26.5%), but the difference was not statistically significant (p>0.05). In the CHG-dressing group, CRBSIs caused by Gram-positive microorganisms totaled 0%, but the figure was 8.8% in the control group (p=0.028).Conclusions:CHG dressings reduced CRBSIs caused by Gram-positive microorganisms.

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What is new for the prevention of catheter-related bloodstream infections?

Cited by 10 publications

References 42 publications

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms

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