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Prevention of Central Venous Catheter-Related Infections by Using Maximal Sterile Barrier Precautions During Insertion

Published online by Cambridge University Press:  02 January 2015

Issam I. Raad ,
David C. Hohn ,
B. Joyce Gilbreath ,
Nabil Suleiman ,
Lou Anne Hill ,
Patricia A. Bruso ,
Kathy Marts ,
Paul F. Mansfield  and
Gerald P. Bodey
Issam I. Raad*
Affiliation:
Department of Medical Specialties, Section of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
David C. Hohn
Affiliation:
Department of General Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
B. Joyce Gilbreath
Affiliation:
Department of Medical Specialties, Section of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Nabil Suleiman
Affiliation:
Department of Medical Specialties, Section of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Lou Anne Hill
Affiliation:
Department of Laboratory Medicine, Section of Infection Control, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Patricia A. Bruso
Affiliation:
Department of Nursing and Infusion Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Kathy Marts
Affiliation:
Department of Nursing and Infusion Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Paul F. Mansfield
Affiliation:
Department of General Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Gerald P. Bodey
Affiliation:
Department of Medical Specialties, Section of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
*
Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030
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Abstract

Objective:

In many hospitals, the only sterile precautions used during the insertion of a nontunneled central venous catheter are sterile gloves and small sterile drapes. We investigated whether the use of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, and large drape) would lower the risk of acquiring catheter-related infections.

Design:

Prospective randomized trial.

Setting:

A 500-bed cancer referral center.

Methods:

We randomized patients to have their nontunneled central catheter inserted under maximal sterile barrier precautions or control precautions (sterile gloves and small drape only). All patients were followed for 3 months postinsertion or until the catheter was removed, whichever came first. Catheter-related infections were diagnosed by quantitative catheter cultures and/or simultaneous quantitative blood cultures.

Results:

The 176 patients whose catheters were inserted by using maximal sterile barrier precautions were comparable to the 167 control patients in underlying disease, degree of immuno-suppression, therapeutic interventions, and catheter risk factors for infections (duration and site of catheterization, number of catheter lumen, catheter insertion difficulty, reason for catheter removal). There were a total of four catheter infections in the test group and 12 in the control group (P=0.03, chi-square test). The catheter-related septicemia rate was 6.3 times higher in the control group (P=0.06, Fisher's exact test). Most (67%) of the catheter infections in the control group occurred during the first 2 months after insertion, whereas 25% of the catheter infections in the maximal sterile precautions group occurred during the same period (P<0.01, Fisher's exact test). Cost-benefit analysis showed the use of such precautions to be highly cost-effective.

Conclusion:

Maximal sterile barrier precautions during the insertion of nontunneled catheters reduce the risk of catheter infection. This practice is cost-effective and is consistent with the practice of universal precautions during an invasive procedure.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 4 , April 1994 , pp. 231 - 238
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1. Raad, II, Bodey, GE Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992;15:197–200.Google Scholar
2. Maki, DG, Goldman, DA, Rhame, FS. Infection control in intravenous therapy. Ann Intern Med 1973;79:867–887.Google Scholar
3. Snydman, DR, Murray, SA, Kornfeld, SJ, Jajka, JA, Ellis, CA. Total parenteral nutrition-related infections. Am J Med 1982;73:695–699.CrossRefGoogle ScholarPubMed
4. Ryan, JA, Abel, RM, Abbott, WM, et al. Catheter complications in total parenteral nutrition. N Engl J Med 1974;290:757–761.CrossRefGoogle ScholarPubMed
5. Hampton, AA, Sherertz, RJ. Vascular-access infections in hospitalized patients. Surg Infect 1988;68:57–71.Google Scholar
6. Cooper, GL, Schiller, AL, Hopkins, CC. Possible role of capillary action in pathogenesis of experimental catheter-associated dermal tunnel infections. J Clin Microbiol 1988;26:8–12.Google Scholar
7. Anaissie, EJ, Raad, II, Samonis, G, et al. Universal colonization of central venous catheters (CVCs) and low risk of hematogenous seeding. In: Proceedings of the American Society for Microbiology 31st Interscience Conference on Antimicrobial Agents and Chemotherapy; September 29-October 2, 1991; Chicago, Illinois. Abstract 1063:276.Google Scholar
8. Raad, II, Costerton, JW, Sabharwal, U, Sacilowski, M, Baba, M, Bodey, GE Central venous catheters (CVC) studied by quantitative cultures and scanning electron microscopy (SEM): The importance of luminal colonization. In: Proceedings of the American Society of Microbiology 31st Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology; 1991:175.Abstract 459.Google Scholar
9. Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:1717–1721.CrossRefGoogle ScholarPubMed
10. Mermel, LA, McCormick, RD, Springman, SR, Maki, DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991;91 (suppl 3B):197–205.Google Scholar
11. Maki, DG. Improving infections caused by intravascular devices: pathogenesis, strategies for prevention. Royal Society of Medicine Services international Congress and Symposium 1991;179:3–27.Google Scholar
12. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter-related infections. N Engl J Med 1977;296:1305–1309.CrossRefGoogle Scholar
13. Sherertz, RJ, Raad, II, Balani, A, et al. Three year experience with sonicated vascular cultures in a clinical microbiology laboratory. J Clin Microbiol 1990;28:76–82.CrossRefGoogle Scholar
14. Tarrand, JJ, Guillot, C, Wenglar, M, et al. Clinical comparison of the resin-containing BACTEC 26 plus and the Isolator 10 blood culturing systems. J Clin Microbiol 1991;29:2245–2249.Google Scholar
15. Weinstein, RA,Kabins, SA. Strategies for prevention and control of multiple drug-resistant nosocomial infections. Am J Med 1981;70:449–454.CrossRefGoogle Scholar
16. Leclair, JM, Freeman, J, Sullivan, BE Crowley, CM, Goldmann, DA Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med 1987;317:329–334.CrossRefGoogle ScholarPubMed
17. Office of the Federal Register, Code of federal regulations: labor. Subpart IV: Occupational exposure to bloodbome pathogens. Final rule. Washington, DC: Office of the Federal Register, National Archives and Records Administration, 1991; (29 CFR§1910.1030)64404–64422.Google Scholar
18. Centers for Disease Control. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40:1–9.Google Scholar
19. Maki, DG, Cobb, L, Garman, JK, Shapiro, JM, Ringer, M, Helgerson, RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 1988;85:307–314.Google Scholar
20. Pittet, D, Tarara, D, Wenzel, RI? Attributable mortality, overall costs and excess length of stay from nosocomial bloodstream infection in SICU patients. In: Proceedings of the American Society for Microbiology 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-14, 1992; Anaheim, California. Abstract 260:154.Google Scholar
21. Flowers, RH III, Schwenzer, KJ, Kopel, RF, Fisch, MJ, Tucker, SI, Farr, BM. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. JAMA 1989;261:878–883.CrossRefGoogle ScholarPubMed
22. Kamal, GD, Pfaller, MA, Rempe, LE, Jebson, PJR. Reduced intravascular catheter infection by antibiotic bonding. JAMA 1991;265:2364–2368.CrossRefGoogle ScholarPubMed