CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011

Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland.
Clinical Infectious Diseases (Impact Factor: 8.89). 04/2011; 52(9):e162-93. DOI: 10.1093/cid/cir257
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Available from: Mark Rupp, Jun 18, 2014
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    • "into the insertion wound) has been identified as a primary route for catheter-related infection,2,4,5,14 with one animal study even suggesting that capillary action plays a role in accelerating the transit of microbes deep into the skin tissue.15 Dressing the insertion site after using an antiseptic to suppress the native microflora is the recommended practice to mitigate the risk of extraluminal infection.3 One limitation of this protocol is that antisepsis takes place at a single point in time. "
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    ABSTRACT: To evaluate the antimicrobial activity of a new, transparent composite film dressing, whose adhesive contains chlorhexidine gluconate (CHG), against the native microflora present on human skin. CHG-containing adhesive film dressings and non-antimicrobial control film dressings were applied to the skin on the backs of healthy human volunteers without antiseptic preparation. Dressings were removed 1, 4 or 7 days after application. The bacterial populations underneath were measured by quantitative cultures (cylinder-scrub technique) and compared with one another as a function of time. The mean baseline microflora recovery was 3.24 log10 cfu/cm(2). The mean log reductions from baseline measured from underneath the CHG-containing dressings were 0.87, 0.78 and 1.30 log10 cfu/cm(2) on days 1, 4 and 7, respectively, compared with log reductions of 0.67, -0.87 and -1.29 log10 cfu/cm(2) from underneath the control film dressings. There was no significant difference between the log reductions of the two treatments on day 1, but on days 4 and 7 the log reduction associated with the CHG adhesive was significantly higher than that associated with the control adhesive. The adhesive containing CHG was associated with a sustained antimicrobial effect that was not present in the control. Incorporating the antimicrobial into the adhesive layer confers upon it bactericidal properties in marked contrast to the non-antimicrobial adhesive, which contributed to bacterial proliferation when the wear time was ≥4 days.
    Journal of Antimicrobial Chemotherapy 04/2014; 69(8). DOI:10.1093/jac/dku096 · 5.31 Impact Factor
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    • "This exposes patients to the potential of catheter-related bloodstream infection (CRBSI). However, the Centers for Disease Control and Prevention (CDC) does not advocate surveillance of CRBSIs for PACs (O'Grady et al. 2002), and many clinicians consider PACs to pose little risk of CRBSI (Maki et al. 2006, Koh et al. 2008). More recent studies dispute this, finding infection risks comparable with those of central venous catheters (Gowardman et al. 2010). "
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    ABSTRACT: This article presents a systematic review of the evidence for the optimal interval for replacement of administration sets for peripheral arterial catheters. Peripheral arterial catheters are attached to administration sets, including transducers, which are changed routinely in some hospitals on the understanding that prolonged duration of administration sets use may cause a higher incidence of infection. Systematic review. Medline, CINAHL, Scopus and the Cochrane Library were searched to access relevant studies published between 1966 and 2011. Inclusion criteria were quantitative studies of critically ill patients with peripheral arterial catheters that required administration sets for intra-arterial pressure monitoring and had a focus on administration sets duration of use. Studies were assessed for quality using either methodological quality assessments from Cochrane guidelines for systematic reviews for randomised controlled trials or with the Newcastle-Ottawa quality assessment scale for cohort studies. Six studies were selected for review. These included three randomised controlled trials (226 patients) and three cohort studies (219 patients). Cohort studies reported 1–4% catheter-related bloodstream infection and 0–8% infusate-related bloodstream infection when administration sets were changed every 48 hours. Two randomised controlled trials found no difference in infusate-related bloodstream infection (two days: 0%; four to eight days: 1·7%) and found no cases of catheter-related bloodstream infection in any group when administration sets were replaced every 24 or 48 hours. There is limited evidence on the optimum duration of administration sets used for peripheral arterial catheters. Large randomised trials of high quality are needed. This review provides clinicians with comprehensive information about the state of the evidence in relation to the duration of administration sets for peripheral arterial catheters to inform decision-making and further research.
    Journal of Clinical Nursing 12/2012; 22(3-4). DOI:10.1111/j.1365-2702.2012.04346.x · 1.26 Impact Factor
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    • "More recently, also for application of transparent polyurethane dressings and for chlorhexidine-impregnated sponges, it was shown that less-frequent catheter-dressing changes do not increase the risk for catheter infection, while significantly reducing patient discomfort and costs [25,26]. On the basis of the studies described, the CDC guidelines for prevention of catheter-infection advise changing dressings at least every 7 days, but do not advise against more-frequent dressing change [27]. The results of our trial, however, should be interpreted in the context of daily dressing changes. "
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    ABSTRACT: Catheter-related bloodstream infections (CRBSIs) associated with short-term central venous catheters (CVCs) in intensive care unit (ICU) patients are a major clinical problem. Bacterial colonization of the skin at the CVC insertion site is an important etiologic factor for CRBSI. The aim of this study was to assess the efficacy of medical-grade honey in reducing bacterial skin colonization at insertion sites. A prospective, single-center, open-label randomized controlled trial was performed at the ICU of a university hospital in The Netherlands to assess the efficacy of medical-grade honey to reduce skin colonization of insertion sites. Medical-grade honey was applied in addition to standard CVC-site dressing and disinfection with 0.5% chlorhexidine in 70% alcohol. Skin colonization was assessed on a daily basis before CVC-site disinfection. The primary end point was colonization of insertion sites with >100 colony-forming units at the last sampling before removal of the CVC or transfer of the patient from the ICU. Secondary end points were quantitative levels of colonization of the insertion sites and colonization of insertion sites stratified for CVC location. Colonization of insertion sites was not affected by the use of medical-grade honey, as 44 (34%) of 129 and 36 (34%) of 106 patients in the honey and standard care groups, respectively, had a positive skin culture (P = 0.98). Median levels of skin colonization at the last sampling were 1 (0 to 2.84) and 1 (0 to 2.70) log colony-forming units (CFUs)/swab for the honey and control groups, respectively (P = 0.94). Gender, days of CVC placement, CVC location, and CVC type were predictive for a positive skin culture. Correction for these variables did not change the effect of honey on skin-culture positivity. Medical-grade honey does not affect colonization of the skin at CVC insertion sites in ICU patients when applied in addition to standard disinfection with 0.5% chlorhexidine in 70% alcohol. Trial registration Netherlands Trial Registry, NTR1652.
    Critical care (London, England) 10/2012; 16(5):R214. DOI:10.1186/cc11849 · 4.48 Impact Factor
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