Prevention of Intravascular Catheter-Related Infections

Ann Intern Med. 2000 Mar 7;132(5):391-402. doi: 10.7326/0003-4819-132-5-200003070-00009.

Abstract

Purpose: To review the literature on prevention of intravascular catheter-related infections.

Data sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Primary authors were contacted directly if data were incomplete.

Study selection: Studies met the following criteria unless otherwise stated: Trials were prospective and randomized; catheters were inserted into new sites, not into old sites over guidewires; catheter cultures were done by using semi-quantitative or quantitative methods; and, for prospective studies, catheter-related bloodstream infection was confirmed by microbial growth from percutaneously drawn blood cultures that matched catheter cultures.

Data extraction: Data on population, methods, preventive strategy, and outcome (measured as catheter-related bloodstream infections) were gathered. The quality of the data was graded by using preestablished criteria.

Data synthesis: The recommended preventive strategies with the strongest supportive evidence are full barrier precautions during central venous catheter insertion; subcutaneous tunneling short-term catheters inserted in the internal jugular or femoral veins when catheters are not used for drawing blood; contamination shields for pulmonary artery catheters; povidone-iodine ointment applied to insertion sites of hemodialysis catheters; specialized nursing teams caring for patients with short-term peripheral venous catheters, especially at institutions with a high incidence of catheter-related infection; no routine replacement of central venous catheters; antiseptic chamberfilled hub or hub-protective antiseptic sponge for central venous catheters; and use of chlorhexidine-silver sulfadiazine-impregnated or minocycline-rifampin-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies that do not incorporate antimicrobial agents (for example, maximal barrier precautions).

Conclusions: Simple interventions can reduce the risk for serious catheter-related infection. Adequately powered randomized trials are needed.

Publication types

  • Meta-Analysis

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Bacteremia / prevention & control*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / methods
  • Catheters, Indwelling / adverse effects*
  • Equipment Contamination
  • Humans
  • Infection Control / methods*
  • Randomized Controlled Trials as Topic
  • Skin / microbiology

Substances

  • Anti-Infective Agents