Guidelines for the Prevention of Intravascular Catheter–Related Infections

Abstract These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device–Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

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Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Out-of-Hospital Settings: A Consensus Panel Report

Infection Control and Hospital Epidemiology ◽

10.1086/501569 ◽

1999 ◽

Vol 20 (10) ◽

pp. 695-705 ◽

Cited By ~ 28

Author(s):

Candace Friedman ◽

Marcie Barnette ◽

Alfred S. Buck ◽

Rosemary Ham ◽

Jo-Ann Harris ◽

...

Keyword(s):

Health Care ◽

Infection Control ◽

Health Care Workers ◽

Evidence Based ◽

Consensus Panel ◽

Critical Data ◽

Policies And Procedures ◽

Care Workers ◽

Healthcare Epidemiology ◽

And Training

AbstractIn 1997 the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in out-of-hospital settings. The following report represents the Consensus Panel's best assessment of requirements for a healthy and effective out-of-hospital-based infection control and epidemiology program. The recommendations fall into 5 categories: managing critical data and information; developing and recommending policies and procedures; intervening directly to prevent infections; educating and training of health care workers, patients, and nonmedical caregivers; and resources. The Consensus Panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee.

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Guidelines for the Prevention of Intravascular Catheter–Related Infections

Infection Control and Hospital Epidemiology ◽

10.1086/502007 ◽

2002 ◽

Vol 23 (12) ◽

pp. 759-769 ◽

Cited By ~ 216

Author(s):

Naomi P. O'Grady ◽

Mary Alexander ◽

E. Patchen Dellinger ◽

Julie L. Gerberding ◽

Stephen O. Heard ◽

...

Keyword(s):

Healthcare Providers ◽

Venous Catheter ◽

Education And Training ◽

Blood Stream ◽

Central Venous Catheters ◽

Successful Implementation ◽

Central Venous ◽

Catheter Related Infection ◽

Skin Antisepsis ◽

And Training

Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.

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Guidelines for the Prevention of Intravascular Catheter–Related Infections

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700080577 ◽

2002 ◽

Vol 23 (12) ◽

pp. 759-769 ◽

Cited By ~ 142

Author(s):

Naomi P. O'Grady ◽

Mary Alexander ◽

E. Patchen Dellinger ◽

Julie L. Gerberding ◽

Stephen O. Heard ◽

...

Keyword(s):

Healthcare Providers ◽

Venous Catheter ◽

Education And Training ◽

Blood Stream ◽

Central Venous Catheters ◽

Successful Implementation ◽

Central Venous ◽

Catheter Related Infection ◽

Skin Antisepsis ◽

And Training

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Critical Care Nurses’ Knowledge of Evidence-Based Guidelines for Preventing Infections Associated With Central Venous Catheters: An Evaluation Questionnaire

American Journal of Critical Care ◽

10.4037/ajcc2008.17.1.65 ◽

2008 ◽

Vol 17 (1) ◽

pp. 65-71 ◽

Cited By ~ 41

Author(s):

S. Labeau ◽

A. Vereecke ◽

D.M. Vandijck ◽

B. Claes ◽

S.I. Blot

Keyword(s):

Critical Care ◽

Content Validity ◽

Item Difficulty ◽

Central Venous Catheters ◽

Critical Care Nurses ◽

Evidence Based ◽

Central Venous ◽

Response Alternatives ◽

Evidence Based Guidelines

Background Lack of adherence to recommended evidence-based guidelines for preventing infections associated with use of central venous catheters may be due to nurses’ lack of knowledge of the guidelines. Objective To develop a reliable and valid questionnaire for evaluating critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters. Methods A total of 10 nursing-related strategies were identified from current evidence-based guidelines for preventing infections associated with use of central venous catheters. Face and content validation were determined for selected interventions and multiple-choice questions (1 question per intervention). The test results of 762 critical care nurses were evaluated for item difficulty, item discrimination, and quality of the response alternatives or options for answers (possible responses). Results All 10 items had face and content validity. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.05 to 0.41. The quality of the response alternatives (0.0–0.8) indicated widespread misconceptions among the critical care nurses in the sample. Conclusion The questionnaire is reliable and has face and content validity. Findings from surveys in which this questionnaire is used can lead to better educational programs for critical care nurses on infections associated with use of central venous catheters.

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Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.822 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s258-s258

Author(s):

Madhuri Tirumandas ◽

Theresa Madaline ◽

Gregory David Weston ◽

Ruchika Jain ◽

Jamie Figueredo

Keyword(s):

Critical Care ◽

High Risk ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

High Risk Population ◽

Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

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The Use of 2% Chlorhexidine (CHG) Skin Antisepsis for the Prevention of Infection with Central Venous Catheters (CVC) in a Neonatal Intensive Care Unit (NICU)

American Journal of Infection Control ◽

10.1016/j.ajic.2007.04.144 ◽

2007 ◽

Vol 35 (5) ◽

pp. E173-E174

Author(s):

M.D. Honeycutt ◽

S.B. Curry ◽

K.C. Frost ◽

G. Goins ◽

C.H. Gilliam

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Central Venous Catheters ◽

Central Venous ◽

Prevention Of Infection ◽

Skin Antisepsis

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Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group

JAMA ◽

10.1001/jama.274.22.1800 ◽

1995 ◽

Vol 274 (22) ◽

pp. 1800-1804 ◽

Cited By ~ 102

Author(s):

G. H. Guyatt

Keyword(s):

Health Care ◽

Evidence Based Medicine ◽

Working Group ◽

Medical Literature ◽

Evidence Based ◽

Based Medicine

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Heparin Locking for Central Venous Catheters

Journal of the Association for Vascular Access ◽

10.2309/java.11-4-17 ◽

2006 ◽

Vol 11 (4) ◽

pp. 224-231 ◽

Cited By ~ 17

Author(s):

Lynn Hadaway

Keyword(s):

Health Care ◽

Literature Review ◽

Health Care Professionals ◽

New Technology ◽

Central Venous Catheters ◽

Central Venous ◽

Lock Solution ◽

Continued Use ◽

Careful Assessment ◽

Heparin Lock

Abstract Traditionally, heparin-lock solution has been used with all central venous catheters. The introduction of new technology calling for the elimination of heparin and the growing concerns about the use of heparin have caused many health care professionals to question its continued use for this purpose. This literature review attempts to answer the most common questions using available research; however, there continues to be more questions than answers. At present, it appears that some farm of anticoagulant will produce more patent catheters, and heparin-lock solution is the only product commercially available. This situation drives the need for a careful assessment of patients' needs prior to abandoning the use of heparin.

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Impact of Educational Interventions on Compliance with Infection Control Policy for Insertion and Maintenance of Central Venous Catheters

American Journal of Infection Control ◽

10.1016/j.ajic.2007.04.091 ◽

2007 ◽

Vol 35 (5) ◽

pp. E84-E85

Author(s):

C.A. Stamilio ◽

H.H. Hardenstine ◽

K.A. Rivera ◽

R.L. Smith ◽

J.M. Wolfgang

Keyword(s):

Infection Control ◽

Control Policy ◽

Educational Interventions ◽

Central Venous Catheters ◽

Central Venous ◽

Infection Control Policy

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Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.28.3.151 ◽

2009 ◽

Vol 28 (3) ◽

pp. 151-155 ◽

Cited By ~ 36

Author(s):

Sabra Curry ◽

Michele Honeycutt ◽

Gail Goins ◽

Craig Gilliam

Keyword(s):

High Risk ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous Catheters ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Skin Antisepsis ◽

Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

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