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Abstract
Healthcare-associated infections (HAIs) are a leading cause of morbidity and mortality in hospitalized patients. Up to 15% of patients develop an infection while hospitalized in the United States, which accounts for approximately 1.7 million HAIs, 99,000 deaths annually and over 10 billion dollars in costs per year. A significant percentage of HAIs are preventable using evidenced-based strategies. In terms of device-related HAIs it is estimated that 65-70% of catheter-line associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are preventable. To prevent CLABSIs a bundle which includes hand hygiene prior to insertion and catheter manipulation, use of chlorhexidene alcohol for site preparation and maintenance, use of maximum barrier for catheter insertion, site selection, removing nonessential lines, disinfect catheter hubs before assessing line, and dressing changes are essential elements of basic practices. To prevent CAUTIs a bundle that includes hand hygiene for insertion and catheter or bag manipulation, inserting catheters for appropriate indications, insert using aseptic technique, remove catheters when no longer needed, maintain a close system keeping bag and tubing below the bladder are the key components of basic practices.
Highlights
Health care-associated infections (HAIs) are a leading cause of morbidity and mortality in hospitalized patients
Since 2011, hospitals have been required to report central line-associated bloodstream infections (CLABSIs) among patients in intensive care units (ICUs) to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) in order to qualify for annual payment updates
Antimicrobial-/antiseptic-impregnated catheters: Use of a chlorhexidine/silver sulfadiazine- or minocycline/ rifampin-impregnated central venous catheter (CVC) in adults whose catheter is expected to remain in place for more than 5 days has been shown to reduce the risk of CLABSIs28,29
Summary
Health care-associated infections (HAIs) are a leading cause of morbidity and mortality in hospitalized patients. Antimicrobial-/antiseptic-impregnated catheters: Use of a chlorhexidine/silver sulfadiazine- or minocycline/ rifampin-impregnated CVC in adults whose catheter is expected to remain in place for more than 5 days has been shown to reduce the risk of CLABSIs28,29. Use a CHG-containing dressing for CVPs in patients over 2 months of age: in a large multicenter randomized controlled trial, the investigators compared chlorhexidineimpregnated sponge dressing versus standard dressings in ICU patients They found a significant reduction in CLABSIs (6/1953 catheters, 0.40 versus 17/1825 catheters, 1.3 per 1000 catheter-days; hazard ratio 0.24, 95% CI 0.09 to 0.65)[30]. The authors found that the use of antimicrobial lock solutions led to a 69% reduction in CLABSI rate (RR 0.31, 95% CI 0.24 to 0.40) and a 32% reduction in the rate of exit site infections (RR 0.68, 95% CI 0.49 to 0.95) compared with heparin They concluded that antimicrobial lock solutions are effective at reducing CLABSIs in select populations and are additive to basic practices[34]. Perform regular pericare and incontinence care to keep catheter clean
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