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Prevention of intravascular catheter-related infections

INTRODUCTION

Infection, phlebitis, and less often bacteremia remain a major problem with intravascular catheters [1]. The majority of serious catheter-related bloodstream infections are associated with central venous catheters (CVCs), particularly those placed in an intensive care unit [2]. CVC-related bloodstream infection is likely if a primary bloodstream infection develops in a patient who had a CVC within the 48-hour period before the development of the bloodstream infection. If the time interval is longer than 48 hours, there must be compelling evidence that the infection was related to the vascular access device. (See "Definitions and epidemiology of nosocomial intravascular catheter-related (primary) bloodstream infections".)

Strict adherence to hand hygiene recommendations and the use of aseptic techniques during insertion and dressing changes remain the most important measures for the prevention of catheter-associated infections. These measures are emphasized in guidelines from the Healthcare Infection Control Practices Advisory Committee (HICPAC), the Centers for Disease Control and Prevention (CDC), and a working group composed of members from professional organizations representing a variety of medical disciplines [2,3].

Other preventive measures include:

  • Choosing appropriate sites for catheter insertion
  • Using the appropriate type of catheter material
  • Using barrier precautions during insertion
  • Changing catheter administration sets at appropriate intervals
  • Ensuring proper catheter-site care
  • Ensuring removal of catheters when no longer essential

The importance of the location, duration, catheter material, and catheter care will be reviewed here, and recommendations presented for the prevention of infections associated with different types of intravascular catheters (table 1). Issues related to the definitions, epidemiology (including bacteriology), diagnosis, and treatment of intravascular catheter-associated infections, both local and systemic, are discussed separately. (See "Definitions and epidemiology of nosocomial intravascular catheter-related (primary) bloodstream infections" and "Central venous catheter-related infections: Types of devices and definitions" and "Diagnosis of intravascular catheter-related infections" and "Treatment of intravascular catheter-related infections".)
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