The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. The most frequent causative organisms for CRBSI are coagulase-negative staphylococci (CoNSs), Staphylococcus aureus, enterococci, and Candida species. The path to infection frequently includes migration of skin organisms at the insertion site into the cutaneous catheter tract, resulting in microbial colonization of the catheter tip and formation of biofilm. Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of antiseptic dressings, and the use of antiseptic or antibiotic impregnated catheters. Achieving and maintaining very low rates of CRBSI requires a multidisciplinary approach involving the entire health care team, the use of novel technologies in patients with the highest risk of CRBSI, and frequent reeducation of staff.
Mermel LAPrevention of intravascular catheter-related infections. Ann Intern Med. 2000;132(5):391-402.
2.
Coello R., Charlett A., Ward V., et al. Device-related sources of bacteraemia in English hospitals-opportunities for the prevention of hospital-acquired bacteraemia. J Hosp Infect. 2003; 53(1):46-57.
3.
van der Kooi TI, de Boer AS, Mannien J., et al. Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system. Intensive Care Med. 2007;33(2):271-278.
4.
Wisplinghoff H., Bischoff T., Tallent SM, Seifert H., Wenzel RP, Edmond MBNosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study . Clin Infect Dis. 2004 ;39(3):309-317.
5.
Maki DG, Kluger DM, Crnich CJThe risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-1171.
6.
Pittet D., Tarara D., Wenzel RPNosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271(20):1598-1601.
7.
Pronovost P. , Needham D., Berenholtz S., et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-2732.
8.
Yilmaz G., Caylan R., Aydin K., Topbas M., Koksal I.Effect of education on the rate of and the understanding of risk factors for intravascular catheter-related infections. Infect Control Hosp Epidemiol. 2007;28(6):689-694.
9.
Pronovost PJ , Goeschel CA, Wachter RMThe wisdom and justice of not paying for ‘‘preventable complications. ’’ JAMA. 2008;299(18):2197-2199.
10.
Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TCNational Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control . 2008;36(9):609-626.
11.
Gaynes R., Edwards JROverview of nosocomial infections caused by gram-negative bacilli . Clin Infect Dis. 2005;41(6): 848-854.
12.
Safdar N., Maki DGThe pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30(1):62-67.
13.
Mermel LA, McCormick RD, Springman SR, Maki DGThe pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping . Am J Med. 1991;91(3B):197S-205S.
14.
Maki DG, Weise CE, Sarafin HWA semiquantitative culture method for identifying intravenous-catheter- related infection. N Engl J Med. 1977;296(23):1305-1309.
15.
Raad I., Costerton W., Sabharwal U., Sacilowski M., Anaissie E., Bodey GPUltrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis. 1993;168(2):400-407.
16.
Dobbins BM, Kite P., Kindon A., McMahon MJ, Wilcox MHDNA fingerprinting analysis of coagulase negative staphylococci implicated in catheter related bloodstream infections. J Clin Pathol . 2002;55(11):824-828.
17.
Dobbins BMF , Catton JAF, Kite PP, McMahon MJF, Wilcox MHMEach lumen is a potential source of central venous catheter-related bloodstream infection . Crit Care Med . 2003; 31(6):1688-1690.
18.
Anaissie E. , Samonis G., Kontoyiannis D., et al. Role of catheter colonization and infrequent hematogenous seeding in catheter-related infections. Eur J Clin Microbiol Infect Dis. 1995;14(2): 134-137.
19.
Raad I., Hanna HA, Awad A., et al. Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours? Infect Control Hosp Epidemiol. 2001;22(3):136-139.
20.
Armstrong CW , Mayhall CG, Miller KB, et al. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters. J Infect Dis . 1986;154(5):808-816.
21.
Sherertz RJ , Ely EW, Westbrook DM, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000;132(8):641-648.
22.
Coopersmith CM, Rebmann TL, Zack JE, et al. Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med. 2002; 30(1):59-64.
23.
Warren DKM , Zack JER , Cox MJ, Cohen MM, Fraser VJAn educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center. Crit Care Med . 2003;31(7):1959-1963.
24.
Warren DK, Zack JE, Elward AM, Cox MJ, Fraser VJNosocomial primary bloodstream infections in intensive care unit patients in a nonteaching community medical center: a 21-month prospective study. Clin Infect Dis. 2001;33(8):1329-1335.
25.
Coopersmith CM, Zack JE, Ward MR, et al. The impact of bedside behavior on catheter-related bacteremia in the intensive care unit . Arch Surg. 2004;139(2):131-136.
26.
Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004;32(10):2014-2020.
27.
Sheth NK, Franson TR, Rose HD, Buckmire FL, Cooper JA, Sohnle PGColonization of bacteria on polyvinyl chloride and Teflon intravascular catheters in hospitalized patients. J Clin Microbiol. 1983;18(5):1061-1063.
28.
Vadaux P., Francois P., Lew DP, Waldvogel FAHost factors predisposing to and influencing therapy of foreign body infections . In: Waldvogel FA, Bisno AL, eds. Infections Associated With Medical Devices. Washington, DC: ASM Press;2000:1-26.
29.
Stewart PS, Costerton JWAntibiotic resistance of bacteria in bio-films. Lancet . 2001;358(9276):135-138.
30.
Raad I., Darouiche R., Dupuis J., et al. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections . A randomized, double-blind trial. The Texas Medical Center Catheter Study Group. Ann Intern Med. 1997;127(4):267-274.
31.
Darouiche RO , Raad II, Heard SO, et al. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Eng J Med . 1999;340(1):1-8.
32.
Brun-Buisson C., Doyon F., Sollet JP, Cochard JF, Cohen Y., Nitenberg G.Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled trial. Intensive Care Med. 2004;30(5):837-843.
33.
Rupp ME, Lisco SJ, Lipsett PA, et al. Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med. 2005;143(8):570-580.
34.
Moretti EW, Ofstead CL, Kristy RM, Wetzler HPImpact of central venous catheter type and methods on catheter-related colonization and bacteraemia. J Hosp Infect. 2005;61(2):139-145.
35.
Corral L., Nolla-Salas M., Ibanez-Nolla J., et al. A prospective, randomized study in critically ill patients using the Oligon Vantex catheter. J Hosp Infect. 2003;55(3):212-219.
36.
Ranucci M., Isgro G., Giomarelli PP, et al. Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection. Crit Care Med . 2003;31(1):52-59.
37.
Casey AL, Mermel LA, Nightingale P., Elliott TSAntimicrobial central venous catheters in adults: a systematic review and meta-analysis. Lancet Infect Dis. 2008 ;8(12):763-776.
38.
Maki DG, Stolz SM, Wheeler S., Mermel LAPrevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med. 1997;127(4):257-266.
39.
Rosato AE, Tallent SM, Edmond MB, Bearman GMSusceptibility of coagulase-negative staphylococcal nosocomial bloodstream isolates to the chlorhexidine/silver sulfadiazine-impregnated central venous catheter. Am J Infect Control. 2004;32(8):486-488.
40.
Aslam S., Darouiche ROProlonged bacterial exposure to minocycline/rifampicin-impregnated vascular catheters does not affect antimicrobial activity of catheters. J Antimicrob Chemother. 2007;60(1):148-151.
41.
Munson EL, Heard SO, Doern GVIn vitro exposure of bacteria to antimicrobial impregnated-central venous catheters does not directly lead to the emergence of antimicrobial resistance . Chest. 2004;126(5):1628-1635.
42.
Sampath LA, Tambe SM, Modak SMIn vitro and in vivo efficacy of catheters impregnated with antiseptics or antibiotics: evaluation of the risk of bacterial resistance to the antimicrobials in the catheters. Infect Control Hosp Epidemiol. 2001;22(10): 640-646.
43.
Hanna HA, Raad, II, Hackett B., et al. Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrug-resistant bacteremias in critically ill patients. Chest. 2003;124(3):1030-1038.
44.
Chatzinikolaou I., Hanna H., Graviss L., et al. Clinical experience with minocycline and rifampin-impregnated central venous catheters in bone marrow transplantation recipients: efficacy and low risk of developing staphylococcal resistance . Infect Control Hosp Epidemiol. 2003;24(12):961-963.
45.
O’Grady NP, Alexander M., Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol . 2002;23(12):759-769.
46.
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(6):700-707.
47.
Deshpande KS , Hatem C., Ulrich HL, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med . 2005;33(1):13-20; ; discussion 234-235.
48.
Parienti JJ , Thirion M., Megarbane B., et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA. 2008;299(20):2413-2422.
49.
Raad, II, Luna M., Khalil SA, Costerton JW, Lam C., Bodey GPThe relationship between the thrombotic and infectious complications of central venous catheters. JAMA. 1994;271(13): 1014-1016.
50.
Nagashima G. , Kikuchi T., Tsuyuzaki H., et al. To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization? J Infect Chemother. 2006;12(6):363-365.
51.
Heard SO, Wagle M., Vijayakumar E., et al. Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter- related bacteremia. Arch Intern Med. 1998;158(1):81-87.
52.
Chaiyakunapruk N., Veenstra DL, Lipsky BA, Saint S.Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med. 2002; 136(11):792-801.
53.
Chaiyakunapruk N., Veenstra DL, Lipsky BA, Sullivan SD, Saint S.Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine . Clin Infect Dis. 2003 ;37(6):764-771.
54.
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(4 pt 1):231-238.
55.
Carrer S., Bocchi A., Bortolotti M., et al. Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site . Minerva Anestesiol. 2005;71(5):197-206.
56.
Hind D., Calvert N., McWilliams R., et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 2003;327(7411):361.
57.
Karakitsos D., Labropoulos N., De Groot E., et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care . 2006 ;10(6):R162.
58.
Dement JM, Epling C., Ostbye T., Pompeii LA, Hunt DLBlood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System. Am J Ind Med . 2004;46(6):637-648.
59.
Yamamoto AJ , Solomon JA, Soulen MC, et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol. 2002;13(1):77-81.
60.
Ho KM, Litton E.Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother. 2006;58(2):281-287.
61.
Ruschulte H. , Franke M., Gastmeier P., et al. Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol.2009;88(3):267-272.
62.
Timsit JF, Schwebel C., Bouadma L., et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA.2009;301(12):1231-1241.
63.
Rupp ME, Sholtz LA, Jourdan DR, et al. Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. Clin Infect Dis. 2007;44(11):1408-1414.
64.
Salgado CD, Chinnes L., Paczesny TH, Cantey JRIncreased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital . Infect Control Hosp Epidemiol. 2007;28(6):684-688.
65.
Gillies D., O’Riordan L., Wallen M., Morrison A., Rankin K., Nagy S.Optimal timing for intravenous administration set replacement. Cochrane Database Syst Rev. 2005;(4):CD003588.
66.
Yahav D., Rozen-Zvi B., Gafter-Gvili A., Leibovici L., Gafter U., Paul M.Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized, controlled trials. Clin Infect Dis. 2008;47(1):83-93.
67.
Jaffer Y., Selby NM, Taal MW, Fluck RJ, McIntyre CWA meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection. Am J Kidney Dis . 2008;51(2): 233-241.
68.
Labriola L. , Crott R., Jadoul M.Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant . 2008;23(5):1666-1672.
69.
Raad I., Hanna H., Jiang Y., et al. Comparative activities of daptomycin, linezolid, and tigecycline against catheter-related methicillin-resistant Staphylococcus bacteremic isolates embedded in biofilm. Antimicrob Agents Chemother. 2007; 51(5):1656-1660.
70.
Cook D., Randolph A., Kernerman P., et al. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med. 1997 ;25(8):1417-1424.
71.
O’Grady NP, Alexander M., Dellinger EP, et al, and the Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol . 2002;23(12):759-769.
