RSS Feeds
Reducing the Risk for Catheter-Related Infections: A New Strategy
- Michele L. Pearson, MD; and
- Elias Abrutyn, MD
- Centers for Disease Control and Prevention; Atlanta, GA 30333 Allegheny University of the Health Sciences; Philadelphia, PA 19102 Requests for Reprints: Michele L. Pearson, MD, Hospital Infections Program, Mailstop E-69, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333. Current Author Addresses: Dr. Pearson: Hospital Infections Program, Mailstop E-69, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.
Intravascular catheters are integral to the practice of modern medicine. These devices are used to deliver life-sustaining fluids, such as antimicrobial agents, parenteral nutrition, and blood or blood products, and to monitor the hemodynamic status of critically ill patients. However, a potentially life-threatening complication-infection, particularly bloodstream infection-is associated with the use of intravascular catheters. Several types of catheters are available for clinical use, including short peripheral catheters, midline catheters, peripherally inserted central venous catheters, nontunneled central venous catheters used for the short term, and tunneled central venous catheters used for the long term (for example, Hickman and port catheters). The various types of catheters differ in their associated risk for infection. For example, central venous catheters account for an estimated 90% of all nosocomial bloodstream infections [1], and multilumen central venous catheters have been associated with a higher risk for infection than have single-lumen central venous catheters [2-5].
Among the factors that affect the risk for infections related to central venous catheters are the site at which the catheter is placed, the type of barrier precautions used during catheter insertion, the skill of the person inserting the catheter, and the use of a guidewire to replace an existing catheter; these factors are usually amenable to preventive measures. The Centers for Disease Control and Prevention and the Hospital Infections Control Practices Advisory Committee recently published a revised guideline for the prevention of intravascular device-related infections [6, 7]. The guideline provides recommendations for many of the difficult catheter-related clinical questions frequently encountered by practicing physicians: How does one appropriately diagnose a central venous catheter-related infection? What type of dressing should be used to cover the catheter site? Should antimicrobial ointments be applied to catheter sites? What is the role of guidewire exchange of central venous catheters? What are the …
