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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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