Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T05:53:44.904Z Has data issue: false hasContentIssue false
  • English
  • Français

Preventing Catheter-Associated Bloodstream Infections: A Survey of Policies for Insertion and Care of Central Venous Catheters From Hospitals in the Prevention Epicenter Program

Published online by Cambridge University Press:  21 June 2016

David K. Warren ,
Deborah S. Yokoe ,
Michael W. Climo ,
Loreen A. Herwaldt ,
Gary A. Noskin ,
Gianna Zuccotti ,
Jerome I. Tokars ,
Trish M. Perl  and
Victoria J. Fraser
David K. Warren*
Affiliation:
Washington University School of Medicine, Saint Louis, Missouri
Deborah S. Yokoe
Affiliation:
Harvard Medical School, Boston, Massachusetts
Michael W. Climo
Affiliation:
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
Loreen A. Herwaldt
Affiliation:
University of Iowa College of Medicine, Iowa City, Iowa
Gary A. Noskin
Affiliation:
Northwestern University Medical School, Chicago, Illinois
Gianna Zuccotti
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York
Jerome I. Tokars
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Trish M. Perl
Affiliation:
Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, Saint Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, Saint Louis, MO 63110 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care.

Design.

A 9-page written survey of practices and policies for nontunneled CVC insertion and care.

Setting.

ICUs in 10 academic tertiary-care hospitals.

Participants.

ICU medical directors and nurse managers.

Results.

Twenty-five ICUs were surveyed (1-6 ICUs per hospital). In 80% of the units, 5 separate groups of clinicians inserted 24%-50% of all nontunneled CVCs. In 56% of the units, placement of more than two-thirds of nontunneled CVCs was performed in a single location in the hospital. Twenty units (80%) had written policies for CVC insertion. Twenty-eight percent of units had a policy requiring maximal sterile-barrier precautions when CVCs were placed, and 52% of the units had formal educational programs with regard to CVC insertion. Eighty percent of the units had a policy requiring staff to perform hand hygiene before inserting CVCs, but only 36% and 60% of the units required hand hygiene before accessing a CVC and treating the exit site, respectively.

Conclusion.

ICU policy regarding the insertion and care of CVCs varies considerably from hospital to hospital. ICUs may be able to improve patient outcome if evidence-based guidelines for CVC insertion and care are implemented.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 1 , January 2006 , pp. 8 - 13
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.Google Scholar
2.Raad, I. Intravascular-catheter-related infections. Lancet 1998; 351:893–898.Google Scholar
3.Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000; 132:391–402 [published correction appears in Ann Intern Med 2000;133:5].Google Scholar
4.Crnich, CJ, Maki, DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 2002; 34:1232–1242.CrossRefGoogle ScholarPubMed
5.Raad, II, Hohn, DC, Gilbreath, BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994; 15:231–238.CrossRefGoogle ScholarPubMed
6.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; 91:197S–205S.CrossRefGoogle ScholarPubMed
7.Merrer, J, De Jonghe, B, Golliot, F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001; 286:700–707.Google Scholar
8.Goetz, AM, Wagener, MM, Miller, JM, Muder, RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 1998; 19:842–845.Google Scholar
9.Cobb, DK, High, KP, Sawyer, RG, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992; 327:1062–1068.Google Scholar
10.Cook, D, Randolph, A, Kernerman, P, et al. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 1997; 25:1417–1424.Google Scholar
11.Maki, DG, Ringer, M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters: gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA 1987; 258:2396–2403.Google Scholar
12.Maki, DG, Stolz, SS, Wheeler, S, Mermel, LA. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med 1994; 22:1729–1737.Google Scholar
13.Clemence, MA, Walker, D, Farr, BM. Central venous catheter practices: results of a survey. Am J Infect Control 1995; 23:5–12.Google Scholar
14.Cyna, AM, Hovenden, JL, Lehmann, A, Rajaseker, K, Kalia, P. Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain. BMJ 1998; 316:1944–1945.Google Scholar
15.Guideline for prevention of intravascular device-related infections. Part II. Recommendations for the prevention of nosocomial intravascular device-related infections. Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1996; 24:277–293.Google Scholar
16.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51:1–29.Google ScholarPubMed
17.Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter-related infection. N Engl J Med 1977; 296:1305–1309.Google Scholar
18.Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990; 11:589–594.CrossRefGoogle ScholarPubMed
19.Zimakoff, J, Stormark, M, Larsen, SO. Use of gloves and handwashing behaviour among health care workers in intensive care units: a multicentre investigation in four hospitals in Denmark and Norway. J Hosp Infect 1993; 24:63–67.Google Scholar
20.Groeger, JS, Strosberg, MA, Halpern, NA, et al. Descriptive analysis of critical care units in the United States. Crit Care Med 1992; 20:846–863.Google Scholar
21.O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 2001; 29:352–360.Google Scholar
22.Cabana, MD, Rand, CS, Powe, NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282:1458–1465.CrossRefGoogle ScholarPubMed
23.Oxman, AD, Thomson, MA, Davis, DA, Haynes, RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 1995; 153:1423–1431.Google Scholar
24.Rello, J, Lorente, C, Bodi, M, Diaz, E, Ricart, M, Kollef, MH. Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia? A survey based on the opinions of an international panel of intensivists. Chest 2002; 122:656–661.Google Scholar
25.Warren, DK, Zack, JE, Cox, MJ, Cohen, MM, Fraser, VJ. An educational intervention to prevent catheter-associated bloodstream infections in a non-teaching, community medical center. Crit Care Med 2003; 31:1959–1963.Google Scholar
26.Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004; 32:2014–2020.Google Scholar