The Role of Intravascular Devices in Sepsis.
ABSTRACT Intravascular devices (IVDs) are widely used in modern day health care. Unfortunately, their use is associated with substantial risk of bloodstream infection (BSI) and sepsis, with increased hospitalization and hospital mortality. IVDs are the most common cause of nosocomial BSI. The wider use of new methodologies for diagnosis of IVD-related infection should allow earlier and more focused therapy and, especially, improve the accuracy of surveillance. Of all nosocomial infections, IVD-related BSIs are most amendable to prevention.
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ABSTRACT: Blood stream infections originating from vascular catheters after extended use constitute a major problem in patient care. Ethanol 70% is an important component of cutaneous antiseptics and recent studies suggest that locking the catheter lumen with an ethanol solution (termed "ethanol lock") holds promise as novel technique to prevent infections caused by bacteria which gain access to the lumen of the catheter during clinical use. However, most catheter manufacturers have discouraged use of alcohol with their devices for fear of structural degradation. We report an in-depth investigation to quantify the effect of prolonged ethanol exposure on the mechanical properties of polyurethane vascular catheters. Our results support the wide use of 70% ethanol for prevention of bloodstream infections caused by intravascular devices in clinical practice.
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ABSTRACT: The reduction of central venous line (CVL)-associated bloodstream infections (CLABSIs) is generally advocated. However, despite implementing infection prevention recommendations, CLABSI rates remain high at some institutions. Therefore, a chlorhexidine-containing dressing should be assessed for its potential for infection reduction, adverse events (AEs) and practicability. The number of CVLs, CVL days, CLABSIs and CLABSI rates with regard to the kind of dressing (standard vs. chlorhexidine-containing) were documented from November 2010 to may 2012 (1,298 patients with 12,220 CVL days) at two intensive care units (ICUs) and compared to historical controls. The practicability and safety of the chlorhexidine-containing dressing and reasons for not using this dressing were assessed. Forty CLABSIs occurred in 34 patients, resulting in a significantly lower overall CLABSI rate in patients with the chlorhexidine-containing dressing [1.51/1,000 CVL days; confidence interval (CI): 0.75-2.70] compared to patients with the standard dressing (5.87/1,000 CVL days; CI: 3.93-8.43; p < 0.0001). The CLABSI rate in historical controls receiving the standard dressing was 6.2/1,000 CVL days. The main reason for not using chlorhexidine-containing dressing was bleeding at the insertion site. AEs occurred in five patients and represented self-healing skin macerations (3 cases) and superficial skin necrosis (2 cases). In case of high CLABSI rates despite the implementation of standard recommendations, our findings suggest that a chlorhexidine-containing dressing safely decreases CLABSI rates.Infection 08/2013; 42(1). DOI:10.1007/s15010-013-0519-7 · 2.86 Impact Factor