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7 March 2000 | Volume 132 Issue 5 | Pages 391-402
Purpose: To review the literature on prevention of intravascular catheter-related infections.
Data Sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Primary authors were contacted directly if data were incomplete.
Study Selection: Studies met the following criteria unless otherwise stated: Trials were prospective and randomized; catheters were inserted into new sites, not into old sites over guidewires; catheter cultures were done by using semi-quantitative or quantitative methods; and, for prospective studies, catheter-related bloodstream infection was confirmed by microbial growth from percutaneously drawn blood cultures that matched catheter cultures.
Data Extraction: Data on population, methods, preventive strategy, and outcome (measured as catheter-related bloodstream infections) were gathered. The quality of the data was graded by using preestablished criteria.
Data Synthesis: The recommended preventive strategies with the strongest supportive evidence are full barrier precautions during central venous catheter insertion; subcutaneous tunneling short-term catheters inserted in the internal jugular or femoral veins when catheters are not used for drawing blood; contamination shields for pulmonary artery catheters; povidone-iodine ointment applied to insertion sites of hemodialysis catheters; specialized nursing teams caring for patients with short-term peripheral venous catheters, especially at institutions with a high incidence of catheter-related infection; no routine replacement of central venous catheters; antiseptic chamber-filled hub or hub-protective antiseptic sponge for central venous catheters; and use of chlorhexidine-silver sulfadiazine-impregnated or minocycline-rifampin-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies that do not incorporate antimicrobial agents (for example, maximal barrier precautions).
Conclusions: Simple interventions can reduce the risk for serious catheter-related infection. Adequately powered randomized trials are needed.
Author and Article Information
From Rhode Island Hospital and Brown University School of Medicine, Providence, Rhode Island.
Acknowledgments: The author thanks Gretchen Kai Halpert for technical assistance and Dr. Dennis Maki for inspiration.
Requests for Single Reprints: Leonard Mermel, DO, ScM, Division of Infectious Diseases, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903; e-mail, mailto:lmermel{at}lifespan.org.
Requests To Purchase Bulk Reprints (minimum, 100 copies): Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org. REVIEW
Prevention of Intravascular Catheter–Related Infections
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