Download 19 Search Anti-Infective Agents, Local AND Catheterization

Quesito 2
Quali sono gli antisettici che offrono attualmente le migliori condizioni di
asepsi cutanea in corrispondenza del sito di inserzione del CVC?
Strategia di ricerca (effettuata il 7 aprile 2008 su PubMed)
Articoli pubblicati dal 2000 ad oggi
#1 ("local anti-infective agents"[Text Word] OR "anti-infective agents,
local"[MeSH Terms] OR "anti-infective agents, local"[Pharmacological Action] OR
Anti-Infective Agents, Local[Text Word]) AND ("central venous
catheterization"[Text Word] OR "catheterization, central venous"[MeSH Terms] OR
Catheterization, Central Venous[Text Word]OR CVC OR central venous catheter*)
#2 Search Site care OR skin disinfection OR catheter insertion site* OR
cutaneous antisepsis OR skin antiseptic* OR skin antisepsis OR skin antiseptic
solution* OR cutaneous disinfection
#1 AND #2
1: Am J Infect Control. 2007 Nov;35(9):585-8.
Implementation of chlorhexidine gluconate for central venous catheter site care
at Siriraj Hospital, Bangkok, Thailand.
Balamongkhon B, Thamlikitkul V.
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol
University, Bangkok, Thailand.
BACKGROUND: A meta-analysis and cost-effectiveness analysis of randomized
controlled trials comparing chlorhexidine gluconate with povidone-iodine
solutions for venous catheter site care found that the use of chlorhexidine
gluconate significantly reduced the risk for catheter-related bloodstream
infections and that it was cost-effective. The objective of the study was to
implement locally formulated chlorhexidine gluconate for central venous catheter
(CVC) site care in intensive care units (ICUs) at Siriraj Hospital. METHODS: The
study was conducted in 312 subjects who needed CVC insertions in 3 ICUs from
January to July 2006. One hundred twenty subjects received 2% chlorhexidine
gluconate in 70% alcohol, whereas 192 subjects received 10% povidone-iodine as
the antiseptic solution for CVC site care. The patients were assessed for
CVC-related infections and for any adverse effects of 2% chlorhexidine gluconate
in 70% alcohol. RESULTS: The incidence of CRBSIs in the indwelling CVC subjects
who received 2% chlorhexidine gluconate in 70% alcohol was less than those who
received 10% povidone-iodine during the same period, 3.2 versus 5.6 episodes per
1000 CVC days, respectively (P= .06; OR, 3.26; 95% CI: 0.97-10.92). No adverse
effects related to using 2% chlorhexidine gluconate in 70% alcohol were
observed.
CONCLUSION: The locally formulated 2% chlorhexidine gluconate in 70% alcohol was
safe, effective, and efficient for CVC site care in ICUs at Siriraj Hospital.
Publication Types:
Clinical Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Academic Medical Centers
Anti-Infective Agents, Local/chemistry
Anti-Infective Agents, Local/therapeutic use*
Bacteremia/prevention & control*
Catheterization, Central Venous/adverse effects
Catheters, Indwelling/adverse effects
1
Chlorhexidine/analogs & derivatives*
Chlorhexidine/chemistry
Chlorhexidine/therapeutic use
Cross Infection/prevention & control*
Female
Humans
Infection Control/methods
Intensive Care Units*
Male
Povidone-Iodine/therapeutic use
Practice Guidelines as Topic
Prospective Studies
Thailand
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Povidone-Iodine
Chlorhexidine
PMID: 17980236 [PubMed - indexed for MEDLINE]
2: Arch Intern Med. 2007 Oct 22;167(19):2066-72.
Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for
central venous catheter care.
Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F,
Debaene
B.
Département d'Anesthésie Réanimation, Centre Hospitalier et Universitaire de
Poitiers, 86021 Poitiers, France. [email protected]
BACKGROUND: Although chlorhexidine-based solutions and alcohol-based
povidone-iodine have been shown to be more efficient than aqueous povidoneiodine
for skin disinfection at catheter insertion sites, their abilities to reduce
catheter-related infection have never been compared. METHODS: Consecutively
scheduled central venous catheters inserted into jugular or subclavian veins
were
randomly assigned to be disinfected with 5% povidone-iodine in 70% ethanol or
with a combination of 0.25% chlorhexidine gluconate, 0.025% benzalkonium
chloride, and 4% benzylic alcohol. Solutions were used for skin disinfection
before catheter insertion (2 consecutive 30-second applications separated by a
period sufficiently long to allow for dryness) and then as single applications
during subsequent dressing changes (every 72 hours, or earlier if soiled or
wet).
RESULTS: Of 538 catheters randomized, 481 (89.4%) produced evaluable culture
results. Compared with povidone-iodine, the chlorhexidine-based solution was
associated with a 50% decrease in the incidence of catheter colonization (11.6%
vs 22.2% [P = .002]; incidence density, 9.7 vs 18.3 per 1000 catheter-days) and
with a trend toward lower rates of catheter-related bloodstream infection (1.7%
vs 4.2% [P = .09]; incidence density, 1.4 vs 3.4 per 1000 catheter-days).
Independent risk factors for catheter colonization were catheter insertion into
the jugular vein (adjusted relative risk, 2.01; 95% confidence interval,
1.24-3.24) and use of povidone-iodine (adjusted relative risk, 1.87; 95%
confidence interval, 1.18-2.96). CONCLUSION: Chlorhexidine-based solutions
should
be considered as a replacement for povidone-iodine (including alcohol-based)
formulations in efforts to prevent catheter-related infection.
Publication Types:
2
Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Anti-Infective Agents, Local/pharmacology*
Catheterization, Central Venous*
Chi-Square Distribution
Chlorhexidine/analogs & derivatives*
Chlorhexidine/pharmacology
Cross Infection/prevention & control*
Equipment Contamination/prevention & control*
Female
Humans
Jugular Veins
Male
Middle Aged
Povidone-Iodine/pharmacology*
Risk Factors
Subclavian Vein
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Povidone-Iodine
Chlorhexidine
Secondary Source ID:
ClinicalTrials.gov/NCT00259350
PMID: 17954800 [PubMed - indexed for MEDLINE]
3: J Med Assoc Thai. 2006 Nov;89 Suppl 5:S94-101.
Cost-effectiveness analysis of chlorhexidine gluconate compared with
povidone-iodine solution for catheter-site care in Siriraj Hospital, Thailand.
Maenthaisong R, Chaiyakunapruk N, Thamlikitkul V.
Department of Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand.
BACKGROUND: Catheter-related bloodstream infections (CRBSI) are an important
cause of patient morbidity, mortality, and increased health care costs. Use of
an
antiseptic solution for skin disinfection at the catheter insertion site helps
prevent catheter-related infections. In Thailand, povidone-iodine solution is
the
most commonly used agent for this purpose. However, the results of several
studies including a meta-analysis indicated that the use of chlorhexidine
gluconate is more effective than the use of povidone-iodine as an antiseptic for
preventing CRBSI. This study evaluated the cost-effectiveness of chlorhexidine
gluconate versus povidone-iodine for catheter-site care using the Siriraj
Hospital perspective. MATERIAL AND METHOD: We used a decision analytic modeling
for estimating the cost-effectiveness of antiseptic solutions. The CRBSI rate
was
obtained from the Center for Nosocomial Infection Control at Siriraj Hospital,
while the efficacy of cholorhexidine compared to povidone-idone was based on a
meta-analysis. The cost of managing infections was derived from the Thai Drug
Related Group (DRG). A series of sensitivity analyses were performed. Since the
time horizon of the analysis was less than 1 year, there was no need for
discounting. RESULTS: We found that the use of chlorhexidine, rather than
povidone iodine, for central catheter site care resulted in a 1.61% decrease in
the incidence of CRBSI, a 0.32 % decrease in the incidence of death, and savings
3
of 304 baht per catheter used. For peripheral catheter site care, the results
were similar although the differences were smaller. CONCLUSION: Use of
chlorhexidine gluconate in place of the current standard solution for vascular
catheter site care is a cost-effective method of improving patient safety in
Siriraj Hospital.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
Mesh Terms:
Anti-Infective Agents, Local/therapeutic use*
Catheterization/adverse effects
Catheterization, Central Venous/adverse effects*
Chlorhexidine/analogs & derivatives*
Chlorhexidine/therapeutic use
Cost-Benefit Analysis
Decision Support Techniques
Equipment Contamination
Hospitalization
Humans
Meta-Analysis as Topic
Models, Theoretical
Povidone-Iodine/therapeutic use*
Sepsis/drug therapy*
Sepsis/economics
Thailand
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Povidone-Iodine
Chlorhexidine
PMID: 17718250 [PubMed - indexed for MEDLINE]
4: Curr Opin Infect Dis. 2007 Aug;20(4):360-9.
Prevention of intravascular catheter infection.
Eggimann P.
Department of Adult Intensive Care Medicine and Burn Centre, Centre Hospitalier
Universitaire Vaudois (CHUV), Lausanne, Switzerland. [email protected]
PURPOSE OF REVIEW: To review recent evidence supporting the guidelines for
preventing catheter-related and catheter-associated infections. RECENT FINDINGS:
A series of studies has confirmed, over the past few years, that education-based
preventive programmes can reduce these infections by one half to two thirds. The
evidence supporting some specific measures has increased for the optimal timing
for set replacement, for catheter-site dressing with chlorhexidine-impregnated
devices, and for the use of some coated or impregnated intravascular devices.
SUMMARY: Catheter-related and associated infections are largely preventable and
should not be viewed as an unaffordable tribute to technical medicine.
Improvements in existing techniques and new technologies should all be
integrated
into a structured process of continuous improvement in the quality of care.
Publication Types:
Review
Mesh Terms:
Anti-Infective Agents, Local
4
Bacterial Infections/prevention & control*
Catheterization, Central Venous/adverse effects*
Catheterization, Peripheral/adverse effects
Catheterization, Peripheral/methods
Catheters, Indwelling/adverse effects
Catheters, Indwelling/microbiology
Cross Infection/prevention & control*
Disease Transmission, Professional-to-Patient
Equipment Contamination
Humans
Infection Control*
Practice Guidelines as Topic
Substances:
Anti-Infective Agents, Local
PMID: 17609594 [PubMed - indexed for MEDLINE]
5: Mayo Clin Proc. 2007 Jun;82(6):672-8.
Comment in:
Mayo Clin Proc. 2007 Jun;82(6):665.
1; author reply 1291.
Mayo Clin Proc. 2007 Oct;82(10):1290-
Use of central venous catheter-related bloodstream infection prevention
practices
by US hospitals.
Krein SL, Hofer TP, Kowalski CP, Olmsted RN, Kauffman CA, Forman JH,
Banaszak-Holl J, Saint S.
Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor
Healthcare System, Ann Arbor, Michigan, USA. [email protected]
OBJECTIVE: To examine the extent to which US acute care hospitals have adopted
recommended practices to prevent central venous catheter-related bloodstream
infections (CR-BSIs). PARTICIPANTS AND METHODS: Between March 16, 2005, and
August 1, 2005, a survey of infection control coordinators was conducted at a
national random sample of nonfederal hospitals with an intensive care unit and
more than 50 hospital beds (n=600) and at all Department of Veterans Affairs
(VA)
medical centers (n=119). Primary outcomes were regular use of 5 specific
practices and a composite approach for preventing CR-BSIs. RESULTS: The overall
survey response rate was 72% (n=516). A higher percentage of VA compared to
non-VA hospitals reported using maximal sterile barrier precautions (84% vs 71%;
P=.01); chlorhexidine gluconate for insertion site antisepsis (91% vs 69%;
P<.001); and a composite approach (62% vs 44%; P=.003) combining concurrent use
of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance
of
routine central line changes. Those hospitals having a higher safety culture
score, having a certified infection control professional, and participating in
an
infection prevention collaborative were more likely to use CR-BSI prevention
practices. CONCLUSION: Most US hospitals are using maximal sterile barrier
precautions and chlorhexidine gluconate, 2 of the most strongly recommended
practices to prevent CR-BSIs. However, fewer than half of non-VA US hospitals
reported concurrent use of maximal sterile barrier precautions, chlorhexidine
gluconate, and avoidance of routine central line changes. Wider use of CR-BSI
prevention practices by hospitals could be encouraged by fostering a culture of
safety, participating in infection prevention collaboratives, and promoting
infection control professional certification.
Publication Types:
5
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Mesh Terms:
Anti-Infective Agents/therapeutic use*
Bacteremia/etiology*
Bacteremia/prevention & control*
Catheterization, Central Venous/adverse effects*
Chlorhexidine/analogs & derivatives*
Chlorhexidine/therapeutic use
Data Collection
Hospitals/statistics & numerical data*
Hospitals, Veterans/statistics & numerical data*
Humans
Infection Control/methods*
Infection Control/statistics & numerical data
Intensive Care Units
Logistic Models
United States
Substances:
Anti-Infective Agents
chlorhexidine gluconate
Chlorhexidine
PMID: 17550746 [PubMed - indexed for MEDLINE]
6: Br J Nurs. 2007 Mar 8-21;16(5):278-80.
Skin antiseptics used prior to intravascular catheter insertion.
Adams D, Elliot TS.
Microbiology Research and Development Group, University Hospital Birmingham NHS
Foundation Trust, The Queen Elizabeth Hospital, Edgbaston, Birmingham.
The recent epic2 publication (Pratt et al, 2007) provides evidence-based
guidelines for the prevention of healthcare-associated infections. One of the
new
recommendations related to the prevention of central venous catheter (CVC)
associated infection states that 2% chlorhexidine gluconate (CHG) in 70%
isopropyl alcohol (IPA) should be used for cutaneous antisepsis prior to device
insertion. This article reviews cutaneous antisepsis prior to intravascular
catheter placement.
Publication Types:
Research Support, Non-U.S. Gov't
Review
Mesh Terms:
2-Propanol/therapeutic use
Anti-Infective Agents, Local/therapeutic use*
Catheterization, Central Venous*/adverse effects
Chlorhexidine/analogs & derivatives
Chlorhexidine/therapeutic use
Clinical Trials as Topic
Cross Infection/epidemiology
Cross Infection/etiology
Cross Infection/prevention & control
England/epidemiology
Evidence-Based Medicine
Humans
Infection Control/methods*
6
Infection Control/standards
Povidone-Iodine/therapeutic use
Practice Guidelines as Topic
Sepsis/epidemiology
Sepsis/etiology
Sepsis/prevention & control
Skin Care/methods*
Skin Care/standards
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Povidone-Iodine
Chlorhexidine
2-Propanol
PMID: 17505372 [PubMed - indexed for MEDLINE]
7: Crit Care Med. 2007 Apr;35(4):1032-9.
Comment in:
Crit Care Med. 2007 Apr;35(4):1197-9.
Comparison of silver-impregnated with standard multi-lumen central venous
catheters in critically ill patients.
Kalfon P, de Vaumas C, Samba D, Boulet E, Lefrant JY, Eyraud D, Lherm T, Santoli
F, Naija W, Riou B.
Service de Réanimation Polyvalente, Hôpitaux de Chartres, Chartres, France.
[email protected]
OBJECTIVES: To evaluate a new silver-impregnated multi-lumen central venous
catheter for reducing catheter-related colonization in intensive care patients.
DESIGN: Multicenter, prospective, randomized, controlled clinical study.
SETTING:
Ten adult intensive care units (multidisciplinary, medical and surgical,
university and nonuniversity hospitals) in eight institutions. PATIENTS: A total
of 577 patients who required 617 multi-lumen central venous catheters between
November 2002 and April 2004 were studied. INTERVENTIONS: Intensive care adult
patients requiring multi-lumen central venous catheters expected to remain in
place for >or=3 days were randomly assigned to undergo insertion of
silver-impregnated catheters (silver group) or standard catheters (standard
group). Catheter colonization was defined as the growth of >or=1,000
colony-forming units in culture of the intravascular tip of the catheter by the
vortexing method. Diagnosis of catheter-related infection was performed by an
independent and blinded expert committee. RESULTS: A total of 320 catheters were
studied in the silver group and 297 in the standard group. Characteristics of
the
patients, insertion site, duration of catheterization (median, 11 vs. 10 days),
and other risk factors for infection were similar in the two groups.
Colonization
of the catheter occurred in 47 (14.7%) vs. 36 (12.1%) catheters in the silver
and
the standard groups (p = .35), for an incidence of 11.2 and 9.4 per 1,000
catheter days, respectively. Catheter-related bloodstream infection was recorded
in eight (2.5%) vs. eight (2.7%) catheters in the silver and the standard groups
(p = .88), for an incidence of 1.9 and 2.1 per 1,000 catheter days,
respectively.
CONCLUSION: The use of silver-impregnated multi-lumen catheters in adult
intensive care patients is not associated with a lower rate of colonization than
the use of standard multi-lumen catheters.
7
Publication Types:
Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Anti-Infective Agents, Local*
Bacteria/isolation & purification
Bacterial Infections/microbiology
Bacterial Infections/prevention & control*
Candida/isolation & purification
Catheterization, Central Venous/instrumentation*
Catheters, Indwelling/microbiology*
Colony Count, Microbial
Critical Illness*
Cross Infection/microbiology
Cross Infection/prevention & control
Equipment Contamination
Female
Humans
Intensive Care Units
Male
Middle Aged
Mycoses/microbiology
Mycoses/prevention & control*
Prospective Studies
Silver*
Substances:
Anti-Infective Agents, Local
Silver
PMID: 17334256 [PubMed - indexed for MEDLINE]
8: Am J Infect Control. 2006 Oct;34(8):503-6.
Translating evidence into practice to prevent central venous catheter-associated
bloodstream infections: a systems-based intervention.
Young EM, Commiskey ML, Wilson SJ.
Indiana University School of Medicine, Department of Medicine, Division of
Infectious Diseases, Indianapolis, IN 46202, USA.
BACKGROUND: The central venous catheter (CVC) is a necessary, yet inherently
risky, modern medical device. We aimed to carry out a systems-based intervention
designed to facilitate the use of maximal sterile barrier precautions and the
use
of chlorhexidine for skin antisepsis during insertion of CVC. METHODS: All
patients in whom a CVC was inserted at a medical-surgical intensive care unit at
a university-affiliated public hospital were included in a before-after trial.
The standard CVC kit in routine use before the intervention included a small
sterile drape (24" by 36") and 10% povidone-iodine for skin antisepsis. We
special ordered a customized kit that, instead, included a large sterile drape
(41" by 55") and 2% chlorhexidine gluconate in 70% isopropyl alcohol. Both the
standard kit in use before the intervention and the customized kit included
identical CVCs. Baseline data included the quarterly CVC-associated bloodstream
infection (BSI) rates during the 15 months before the intervention. Comparison
data included the quarterly CVC-associated BSI rates during the 15 months after
we instituted exclusive use of the customized kit. RESULTS: The mean quarterly
CVC-associated BSI rate decreased from a baseline of 11.3 per 1000 CVC-days
before the intervention to 3.7 per 1000 CVC-days after the intervention (P <
8
.01). Assuming direct costs of at least 10,000 dollars per CVC-associated BSI,
we
calculated resultant annualized savings to the hospital of approximately 350,000
dollars. CONCLUSION: Infection control interventions that rely on voluntary
changes in human behavior, despite the best intentions of us all, are often
unsuccessful. We have demonstrated that a systems-based intervention led to a
sustained decrease in the CVC-associated BSI rate, thereby resulting in improved
patient safety and decreased cost of care.
Mesh Terms:
Bacteremia/prevention & control*
Catheterization, Central Venous*
Chlorhexidine*
Cross Infection/prevention & control*
Disinfectants*
Health Care Costs
Hospitals, University
Humans
Infection Control/methods*
Povidone-Iodine
Statistics as Topic
Surgery Department, Hospital
Substances:
Disinfectants
Povidone-Iodine
Chlorhexidine
PMID: 17015155 [PubMed - indexed for MEDLINE]
9: Br J Nurs. 2006 Apr 13-26;15(7):362, 364-8.
Central venous catheter infection in adults in acute hospital settings.
Jones CA.
King's College London.
As well as the human cost, central venous catheter (CVC)-related bloodstream
infections significantly inflate hospital costs, mainly through increased length
of stay in hospital, particularly in intensive care. This literature review
appraises recent research on measures used to minimize CVC-related infection and
compares it with current best practice. Randomized controlled trials and
systematic reviews published on the subject between 2000 and 2005 were reviewed,
concentrating on non-tunnelled, short-term CVCs in the acute hospital setting.
The new evidence mainly backs up current best practice. However, skin
disinfection could be improved by using alcoholic chlorhexidine followed by
aqueous povidone-iodine before CVC insertion. Also, alcoholic chlorhexidine is
the preferred solution for cleaning the hubs/connectors before accessing the
CVC.
Good hand hygiene and quality control and education programmes are vital to
improve patient care. More research is needed to clarify the effectiveness of
certain interventions and technologies, such as antimicrobial CVCs.
Publication Types:
Review
Mesh Terms:
Adult
Anti-Infective Agents, Local/therapeutic use
Bandages
Catheterization, Central Venous/adverse effects*
Catheterization, Central Venous/instrumentation
9
Chlorhexidine/therapeutic use
Critical Care
Critical Illness
Cross Infection/epidemiology*
Cross Infection/etiology
Cross Infection/prevention & control
Humans
Infection Control/methods*
Intensive Care Units*
Povidone-Iodine/therapeutic use
Randomized Controlled Trials as Topic
Risk Factors
Substances:
Anti-Infective Agents, Local
Povidone-Iodine
Chlorhexidine
PMID: 16723935 [PubMed - indexed for MEDLINE]
10: Nurs Manage. 2006 Apr;37(4):54-66; quiz 66-7.
Guarding against vascular site infection.
Rosenthal K.
ResourceNurse.com, Oceanside, NY, USA.
Publication Types:
Review
Mesh Terms:
Administration, Cutaneous
Anti-Infective Agents, Local/administration & dosage
Asepsis/methods
Asepsis/standards
Benchmarking/organization & administration
Catheterization, Central Venous/adverse effects*
Catheterization, Central Venous/nursing
Catheterization, Central Venous/standards
Catheterization, Peripheral/adverse effects*
Catheterization, Peripheral/nursing
Catheterization, Peripheral/standards
Catheters, Indwelling/adverse effects*
Catheters, Indwelling/standards
Centers for Disease Control and Prevention (U.S.)
Chlorhexidine/administration & dosage
Chlorhexidine/analogs & derivatives
Clinical Competence
Cross Infection/epidemiology
Cross Infection/etiology
Cross Infection/prevention & control*
Data Collection
Humans
Infection Control/methods*
Infection Control/standards
Nursing Staff, Hospital/education
Outcome Assessment (Health Care)
Practice Guidelines as Topic
Risk Factors
Skin Care/methods
Skin Care/nursing
Skin Care/standards
10
United States/epidemiology
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Chlorhexidine
PMID: 16603949 [PubMed - indexed for MEDLINE]
11: Dermatology. 2006;212 Suppl 1:47-52.
Our method of povidone-iodine ointment and gauze dressings reduced
catheter-related infection in serious cases.
Fukunaga A, Naritaka H, Fukaya R, Tabuse M, Nakamura T.
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
[email protected]
In experiment 1, we evaluated our method of catheter care at subclavian vein
insertion sites for the control of catheter-related infections in seriously ill
neurosurgical patients who needed prolonged catheter placement, compared with an
older method. In our method, the insertion site was prepared with 10%
povidone-iodine solution, followed by application of 10% povidone-iodine
ointment, and covered with sterile gauze and a transparent polyurethane
dressing.
The older method was based on 1996 guidelines for the prevention of
intravascular
device-related infections. Catheter colonization and mortality were both found
to
be significantly reduced with our method (p = 0.0214, p = 0.0379, respectively).
In experiment 2, we evaluated whether a regimen of catheter care with 10%
povidone-iodine ointment was more effective than that without povidone-iodine
ointment for the prevention of infections. This suggested effectiveness of 10%
povidone-iodine ointment for reduction of infection. Our method of catheter care
was useful even in seriously ill neurosurgical patients.
Mesh Terms:
Administration, Topical
Adult
Aged
Aged, 80 and over
Anti-Infective Agents, Local/administration & dosage*
Bacterial Infections/complications
Bacterial Infections/microbiology
Bacterial Infections/prevention & control*
Bandages
Catheterization, Central Venous/adverse effects*
Catheters, Indwelling/adverse effects
Catheters, Indwelling/microbiology
Cross Infection/complications
Cross Infection/microbiology
Cross Infection/prevention & control*
Equipment Contamination/prevention & control
Humans
Infection Control/methods
Middle Aged
Nervous System Diseases/complications
Nervous System Diseases/surgery
Neurosurgical Procedures
Ointments
Povidone-Iodine/administration & dosage*
Skin Care/methods
11
Solutions
Subclavian Vein
Substances:
Anti-Infective Agents, Local
Ointments
Solutions
Povidone-Iodine
PMID: 16490975 [PubMed - indexed for MEDLINE]
12: Nursing. 2005 Dec;35(12):54-6.
Caring for a nontunneled CVC site.
Hadaway LC.
Lynn Hadaway Associates, Inc., Milner, GA, USA.
Learn current recommendations for preventing catheter-related complications in
an
adult.
Mesh Terms:
Administration, Cutaneous
Anti-Infective Agents, Local/administration & dosage
Bandages
Catheterization, Central Venous/adverse effects
Catheterization, Central Venous/methods
Catheterization, Central Venous/nursing*
Catheters, Indwelling*/adverse effects
Humans
Infection Control/methods*
Nursing Assessment
Patient Education as Topic
Skin Care*/methods
Skin Care*/nursing
Substances:
Anti-Infective Agents, Local
PMID: 16331230 [PubMed - indexed for MEDLINE]
13: Anesth Analg. 2005 Dec;101(6):1778-84.
Central venous catheter colonization in critically ill patients: a prospective,
randomized, controlled study comparing standard with two antiseptic-impregnated
catheters.
Dünser MW, Mayr AJ, Hinterberger G, Flörl CL, Ulmer H, Schmid S, Friesenecker B,
Lorenz I, Hasibeder WR.
Division of General and Surgical Intensive Care Medicine, Department of
Anesthesia and Critical Care Medicine, Innsbruck Medical University,
Anichstrasse
35, 6020 Innsbruck, Austria. [email protected]
In this prospective, randomized, controlled, unblinded study, we compared
colonization rates of a standard, unimpregnated central venous catheter (CVC)
with rates for silver-coated and chlorhexidine-silversulfadiazine
(CH-SS)-impregnated CVC. Patient characteristics, CVC insertion site, indwelling
time, and colonization detected by semiquantitative and quantitative
12
microbiologic techniques were documented. Two-hundred-seventy-five critically
ill
patients were included into the study protocol. One-hundred-sixty standard, 160
silver (S)-coated, and 165 externally impregnated CH-SS CVC were inserted. There
was a significant difference in CVC colonization rates among study groups (P =
0.029). There was no difference in the colonization rate and the colonization
per
1000 catheter days between standard and S-coated (P = 0.564; P = 0.24) or
CH-SS-coated CVC (P= 0.795; P = 0.639). When comparing antiseptic CVC with each
other, colonization rates were significantly less with CH-SS-impregnated than
with S-coated CVC (16.9% versus 7.3%; P = 0.01; 18.2 versus 7.5 of 1000 catheter
days; P = 0.003; relative risk, 0.43; 95% confidence interval, 0.21-0.85).
Whereas standard and S-coated CVC were first colonized 2 and 3 days after
insertion, respectively, CH-SS CVC were first colonized only after 7 days. In
conclusion, antiseptic-impregnated CVC could not prevent catheter colonization
when compared with standard polyurethane catheters in a critical care setting
with infrequent catheter colonization rates and CVC left in place for >10 days.
Publication Types:
Comparative Study
Randomized Controlled Trial
Mesh Terms:
Adult
Aged
Anti-Infective Agents, Local/administration & dosage*
Bacterial Infections/prevention & control*
Catheterization, Central Venous/adverse effects*
Catheterization, Central Venous/instrumentation
Chlorhexidine/administration & dosage*
Critical Illness
Equipment Contamination/prevention & control*
Female
Humans
Male
Middle Aged
Prospective Studies
Silver Sulfadiazine/administration & dosage*
Substances:
Anti-Infective Agents, Local
Silver Sulfadiazine
Chlorhexidine
PMID: 16301258 [PubMed - indexed for MEDLINE]
14: J Hosp Infect. 2005 Oct;61(2):162-7.
Prospective evaluation of a multi-factorial prevention strategy on the impact of
nosocomial infection in very-low-birthweight infants.
Andersen C, Hart J, Vemgal P, Harrison C.
Deparetment of Paediatrics, Mercy Hospital for Women, 126 Clarendon Street East
Melbourne, Melbourne, Victoria 3002, Australia. [email protected]
The aim of this study was to examine the impact of a multi-factorial
intervention
on nosocomial infection in very-low-birthweight infants. Consecutive infants
with
a birth weight less than 1500 g, born between February 2002 and February 2003,
were included in this prospective study. The first six-month period (control)
included surveillance of current practice. The intervention began in the seventh
13
month and included: (i) changes to handwashing solutions with hand hygiene
education; (ii) standardization of intravascular device (IV) insertion with
specialized packs; (iii) changes to skin antiseptic solutions (2% aqueous
chlorhexidine and 1% chlorhexidine in ethanol); and (iv) mandatory removal or
replacement of peripheral IV after 48 hours and removal once enteral intake was
>
120 mL/kg/day. Demographic data and details of every device were collected
prospectively. Bloodstream infections (BSIs), length of stay (LOS), length of
ventilation (LOV) and death were recorded and the rate of nosocomial BSI was
calculated. Overall, 174 newborns required 1359 devices. The two cohorts were
similar for birth weight and gestation. There was a reduction in nosocomial BSIs
from 21% to 9% (control vs. intervention) (P = 0.05, confidence intervals
0.19-1.0). There was no significant difference in LOS, LOV, or mortality. Four
infants had complications from 2% chlorhexidine. In conclusion, implementation
of
the multi-factorial prevention strategy reduced nosocomial BSIs. Alternative
antiseptic solutions are needed to reduce the complications caused by 2% aqueous
chlorhexidine.
Mesh Terms:
Bacteremia/epidemiology
Bacteremia/mortality
Bacteremia/prevention & control*
Catheterization, Central Venous/adverse effects
Catheterization, Central Venous/standards
Chlorhexidine
Cross Infection/epidemiology*
Cross Infection/mortality
Cross Infection/prevention & control*
Female
Handwashing/methods
Humans
Infant, Newborn
Infant, Very Low Birth Weight*
Infection Control/methods*
Infection Control/standards
Length of Stay
Male
Perinatal Care/methods
Perinatal Care/standards
Prospective Studies
Respiration, Artificial
Substances:
Chlorhexidine
PMID: 16240469 [PubMed - indexed for MEDLINE]
15: Infect Control Hosp Epidemiol. 2005 Aug;26(8):703-7.
Octenidine hydrochloride for the care of central venous catheter insertion sites
in severely immunocompromised patients.
Tietz A, Frei R, Dangel M, Bolliger D, Passweg JR, Gratwohl A, Widmer AE.
Division of Hospital Epidemiology, University Hospital Basel, Basel,
Switzerland.
OBJECTIVE: To determine the efficacy and tolerability of octenidine
hydrochloride, a non-alcoholic skin antiseptic, for the care of central venous
catheter (CVC) insertion sites. DESIGN: Prospective, observational study.
SETTING: Bone marrow transplantation unit of a university hospital. PATIENTS:
All
14
consecutive patients with a nontunneled CVC were enrolled prospectively after
informed consent. METHODS: Octenidine hydrochloride (0.1%) was applied for
disinfection at the CVC insertion site during dressing changes. The following
cultures were performed weekly as well as at the occurrence of any systemic
inflammatory response syndrome criteria: cultures of the skin surrounding the
CVC
entry site, cultures of the three-way hub connected to the CVC, blood cultures,
and cultures of the CVC tip on removal. Enhanced microbiological methods (skin
swabs of a 24-cm2 standardized area, roll plate, and sonication of catheter
tips)
were applied. RESULTS: One hundred thirty-five CVCs were inserted in 62 patients
during the study period and remained for a mean period of 19.1 days,
corresponding to 2,462 catheter-days. Bacterial density at the insertion site
declined substantially over time, and most cultures became negative 2 weeks
after
insertion. Only 6 patients had a documented catheter-related bloodstream
infection. The incidence density was 2.39 catheter infections per 1,000
catheter-days. No side effects were noted with application of the antiseptic.
CONCLUSIONS: Disinfection with a skin antiseptic that contains octenidine
hydrochloride is highly active and well tolerated. It leads to a decrease in
skin
colonization over time and may be a new option for CVC care.
Publication Types:
Research Support, Non-U.S. Gov't
Mesh Terms:
Adult
Anti-Infective Agents, Local/therapeutic use*
Catheterization, Central Venous/adverse effects*
Drug Tolerance
Female
Humans
Immunocompromised Host*
Infection Control*
Male
Middle Aged
Prospective Studies
Pyridines/therapeutic use*
Surgical Wound Infection/drug therapy
Surgical Wound Infection/epidemiology
Surgical Wound Infection/prevention & control
Substances:
Anti-Infective Agents, Local
Pyridines
octenidine
PMID: 16156327 [PubMed - indexed for MEDLINE]
16: Pediatr Infect Dis J. 2005 Aug;24(8):676-9.
Chlorhexidine-impregnated dressing for prevention of colonization of central
venous catheters in infants and children: a randomized controlled study.
Levy I, Katz J, Solter E, Samra Z, Vidne B, Birk E, Ashkenazi S, Dagan O.
Department of Pediatric Infectious Diseases, Schneider Children's Medical Center
of Israel, Petah Tiqva, Israel. [email protected]
BACKGROUND: Infections of short term, nontunneled, intravascular catheters are
often caused by migration of organisms from the insertion site. The aim of this
study was to evaluate the effectiveness and safety of a chlorhexidine
15
gluconate-impregnated dressing for the reduction of central venous catheter
(CVC)
colonization and CVC-associated bloodstream infections in infants and children
after cardiac surgery. METHODS: This prospective, randomized, controlled study
was conducted in the pediatric cardiac intensive care unit of a tertiary care
pediatric medical center. Patients 0-18 years of age who were admitted to the
pediatric cardiac intensive care unit during a 14-month period and required a
CVC
for >48 hours were randomized to receive a transparent polyurethane insertion
site dressing (control group) or a chlorhexidine gluconate-impregnated sponge
(Biopatch) dressing covered by a transparent polyurethane dressing (study
group).
The main outcome measures were rates of bacterial colonization, rates of
CVC-associated bloodstream infections and adverse events. RESULTS: Seventy-one
patients were randomized to the control group and 74 to the study group. There
were no significant between group differences in age, sex, Pediatric Risk of
Mortality score or cardiac severity score. CVC colonization occurred in 21
control patients (29%) and 11 (14.8%) study patients (P = 0.0446; relative risk,
0.6166; 95% confidence interval, 0.3716-1.023). Bloodstream infection occurred
in
3 patients (4.2%) in the control group and 4 patients (5.4%) in the study group.
Local redness was noted in 1 control patient and 4 study group patients.
CONCLUSIONS: The chlorhexidine gluconate-impregnated sponge is safe and
significantly reduces the rates of CVC colonization in infants and children
after
cardiac surgery.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Mesh Terms:
Administration, Cutaneous
Adolescent
Anti-Infective Agents, Local/administration & dosage*
Bandages
Catheterization, Central Venous/adverse effects*
Catheters, Indwelling/adverse effects
Catheters, Indwelling/microbiology*
Child
Child, Preschool
Chlorhexidine/administration & dosage
Chlorhexidine/analogs & derivatives*
Equipment Contamination/prevention & control*
Female
Humans
Infant
Male
Prospective Studies
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Chlorhexidine
PMID: 16094219 [PubMed - indexed for MEDLINE]
17: Infect Control Hosp Epidemiol. 2005 Jun;26(6):525-33.
Comment in:
Infect Control Hosp Epidemiol. 2005 Jun;26(6):511-4.
Why is it that internists do not follow guidelines for preventing intravascular
16
catheter infections?
Rubinson L, Wu AW, Haponik EE, Diette GB.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns
Hopkins University, Baltimore, Maryland, USA. [email protected]
BACKGROUND AND OBJECTIVE: High morbidity of CVC-related infections has led to
national guidelines for their prevention. Despite recommendations for the use of
maximal barrier precautions (mask, sterile gloves, gown, and large drape) and
skin antisepsis with 2% chlorhexidine gluconate during CVC insertion, internists
in the United States are not implementing these practices frequently. This study
sought to identify and characterize the obstacles to and potential opportunities
for improving adherence. DESIGN: Cross-sectional survey. PARTICIPANTS: One
thousand randomly selected physician-members of the American College of
Physicians-American Society of Internal Medicine. METHODS: Several potential
determinants of adherence to maximal barrier precautions were assessed,
including
awareness of, agreement with, and ability to implement the recommendation, as
well as the practice and training characteristics of the respondents. Factors
influencing antiseptic selection were also recorded. RESULTS: Of 526
respondents,
178 (34%) had recently inserted CVCs. Clinician experience and subspecialty,
awareness of CDC guidelines, and external influences (eg, time to collect
equipment) did not affect maximal barrier precautions adherence. The only
independent predictor of adherence was high outcome expectancy for the use of
large sterile drapes (OR, 5.3; CI95, 2.2-12.6). Availability had the greatest
influence on internists' selection of specific antiseptic agents, whereas cost
was the least important determinant. CONCLUSIONS: Despite established efficacy,
use of maximal barrier precautions and chlorhexidine gluconate is low among
internists. Because improved adherence to these practices will require increased
outcome expectancy for maximal barrier precautions and availability of
chlorhexidine gluconate, targeting these areas through focused education and
systems modifications is essential.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Mesh Terms:
Anti-Infective Agents, Local/administration & dosage
Antisepsis/standards
Attitude of Health Personnel
Awareness
Catheterization, Central Venous/adverse effects
Catheterization, Central Venous/standards*
Catheterization, Central Venous/statistics & numerical data
Chlorhexidine/administration & dosage
Chlorhexidine/analogs & derivatives
Clinical Competence/standards
Cross Infection/etiology
Cross Infection/prevention & control*
Cross-Sectional Studies
Education, Medical, Continuing
Equipment Contamination/prevention & control
Guideline Adherence/standards*
Health Knowledge, Attitudes, Practice
Health Services Needs and Demand
Humans
Infection Control/standards*
Internal Medicine/education
Internal Medicine/standards*
Multivariate Analysis
17
Physician's Practice Patterns/standards
Physician's Practice Patterns/statistics & numerical data
Practice Guidelines as Topic*
Questionnaires
United States
Substances:
Anti-Infective Agents, Local
chlorhexidine gluconate
Chlorhexidine
Grant Support:
1K23-HL004266-01A1/HL/United States NHLBI
5T32-HL007534-19/HL/United States NHLBI
PMID: 16018427 [PubMed - indexed for MEDLINE]
18: Contact Dermatitis. 2004 Jul;51(1):39-40.
Curcumin allergy in relation to yellow chlorhexidine solution used for skin
disinfection prior to surgery.
Fischer LA, Agner T.
National Allergy Research Centre, Gentofte Hospital, DK-2820 Gentofte, Denmark.
[email protected]
Publication Types:
Case Reports
Mesh Terms:
Allergens/adverse effects*
Catheterization, Central Venous/adverse effects
Chlorhexidine/adverse effects*
Curcumin/adverse effects*
Dermatitis, Allergic Contact/diagnosis*
Dermatitis, Allergic Contact/etiology
Dermatitis, Allergic Contact/pathology
Diagnosis, Differential
Disinfectants/adverse effects*
Female
Humans
Male
Middle Aged
Orthopedic Procedures/adverse effects
Patch Tests
Preoperative Care/adverse effects
Substances:
Allergens
Disinfectants
Curcumin
Chlorhexidine
PMID: 15291836 [PubMed - indexed for MEDLINE]
19: Crit Care Med. 2004 Mar;32(3):708-13.
Comment in:
Crit Care Med. 2004 Mar;32(3):887-8.
Alcoholic povidone-iodine to prevent central venous catheter colonization: A
randomized unit-crossover study.
18
Parienti JJ, du Cheyron D, Ramakers M, Malbruny B, Leclercq R, Le Coutour X,
Charbonneau P; Members of the NACRE Study Group.
Departments of Medical Intensive Care Unit, Côte de Nacre University Hospital,
Caen, France. [email protected]
OBJECTIVE: To compare effectiveness in preventing central venous catheter
colonization and infection of two protocols of cutaneous antisepsis using
povidone-iodine solution in combination with ethanol or water. DESIGN:
Randomized
trial. SETTING: Medical intensive care department in a university hospital.
PATIENTS: Consecutive patients requiring central venous catheter in two similar
11-bed units from January 1, 2001, to January 1, 2002. INTERVENTIONS: Alcoholic
povidone-iodine solution protocol was randomly assigned to one of two units when
the study began. Every 3 months the alcoholic protocol was switched from one
unit
to the other. Depending on the unit and the time the patient was admitted,
catheters were inserted and cared for with 10% aqueous povidone-iodine solution
or 5% povidone-iodine solution 70% ethanol-based combination. MEASUREMENTS AND
MAIN RESULTS: Rates of catheter colonization, catheter-related bacteremia, and
catheter-related infection were compared in the two protocols; 223 catheters
were
included in an intent-to-treat analysis. The incidence of catheter colonization
was significantly lower in the alcoholic povidone-iodine solution protocol than
in the aqueous povidone-iodine solution protocol (relative risk, 0.38; 95%
confidence interval, 0.22-0.65, p <.001), and so was the incidence of
catheter-related infection (relative risk, 0.34; 95% confidence interval,
0.13-0.91, p <.04). Catheter-related bacteremia were similar in both protocols.
After adjusting for other risk factors, time to central venous catheter
colonization was significantly longer in the alcoholic solution (adjusted
hazards
ratio, 0.3; 95% confidence interval, 0.2-0.6, p <.001). Based on a subgroup of
114 patients (57 in each protocol), analysis of 57 pairs of central venous
catheters matched for age, duration, and site of insertion found similar results
regarding the superiority of alcoholic povidone-iodine solution in preventing
central venous catheter colonization and infection. CONCLUSIONS: The use of
alcoholic povidone-iodine for skin disinfection reduced the incidence of
catheter
colonization and related infection compared with aqueous 10% povidone-iodine
disinfection in an adult intensive care unit.
Publication Types:
Clinical Trial
Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Anti-Infective Agents, Local/chemistry*
Anti-Infective Agents, Local/therapeutic use
Catheterization, Central Venous/adverse effects
Catheterization, Central Venous/methods*
Catheters, Indwelling
Cross Infection/epidemiology
Cross Infection/etiology
Cross Infection/mortality
Cross Infection/prevention & control
Cross-Over Studies
Equipment Contamination/prevention & control
Ethanol*
France/epidemiology
19
Humans
Incidence
Matched-Pair Analysis
Middle Aged
Multivariate Analysis
Povidone-Iodine/chemistry*
Povidone-Iodine/therapeutic use
Proportional Hazards Models
Skin/microbiology
Vehicles*
Water*
Substances:
Anti-Infective Agents, Local
Vehicles
Povidone-Iodine
Ethanol
Water
PMID: 15090951 [PubMed - indexed for MEDLINE]
20: Intensive Care Med. 2004 Jun;30(6):1081-8. Epub 2004 Apr 15.
Combined skin disinfection with chlorhexidine/propanol and aqueous
povidone-iodine reduces bacterial colonisation of central venous catheters.
Langgartner J, Linde HJ, Lehn N, Reng M, Schölmerich J, Glück T.
Department of Internal Medicine I, University Medical Centre, University of
Regensburg, 93042 Regensburg, Germany. [email protected]
OBJECTIVE: Central venous catheter (CVC)-related infections may be caused by
micro-organisms introduced from the skin surface into deeper tissue at the time
of CVC insertion. The optimal disinfection regimen to avoid catheter-related
infections has not yet been defined. This study compares three different
approaches. DESIGN: Prospective randomised trial. SETTING: A tertiary care
hospital. PATIENTS AND PARTICIPANTS: One hundred nineteen patients scheduled
electively to receive 140 CVCs. INTERVENTIONS: Skin disinfection was performed
with either povidone-iodine 10% (PVP-iodine), chlorhexidine 0.5%/propanol 70%,
or
chlorhexidine 0.5%/propanol 70% followed by PVP-iodine 10%. Prior to
disinfection, a swab from the site of insertion was taken for culture. CVCs were
removed if no longer needed or infection was suspected. All catheters were
cultured quantitatively after removal. MEASUREMENT AND RESULTS: Bacteria could
be
isolated from 20.7% of the catheter tips. Bacterial growth was found in 30.8% of
the catheters placed after skin disinfection with povidone-iodine, in 24.4%
after
disinfection with propanol/chlorhexidine and in 4.7% after disinfection with
propanol/chlorhexidine followed by povidone-iodine ( p=0.006). In 15 cases, the
same organism was isolated from the skin swab and the catheter tip. Ten of these
paired isolates showed the same pattern in a pulsed-field gel electrophoresis
analysis. CONCLUSIONS: Skin disinfection with propanol/chlorhexidine followed by
PVP-iodine was superior in the prevention of microbial CVC colonisation compared
to either of the regimens alone. These results support the concept that catheter
infections can originate from bacterial translocation at the time of catheter
insertion.
Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
20
Mesh Terms:
1-Propanol/therapeutic use*
Anti-Infective Agents, Local/therapeutic use*
Bacterial Infections/epidemiology
Bacterial Infections/etiology
Bacterial Infections/prevention & control
Catheterization, Central Venous/adverse effects
Catheterization, Central Venous/methods*
Chlorhexidine/therapeutic use*
Cross Infection/epidemiology
Cross Infection/etiology
Cross Infection/prevention & control
Disinfection/methods*
Equipment Contamination/prevention & control
Equipment Contamination/statistics & numerical data
Female
Germany/epidemiology
Humans
Male
Middle Aged
Povidone-Iodine/therapeutic use*
Prospective Studies
Skin/microbiology
Substances:
Anti-Infective Agents, Local
Povidone-Iodine
Chlorhexidine
1-Propanol
PMID: 15085323 [PubMed - indexed for MEDLINE]
21: Intensive Care Med. 2004 May;30(5):837-43. Epub 2004 Apr 2.
Prevention of intravascular catheter-related infection with newer
chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled
trial.
Brun-Buisson C, Doyon F, Sollet JP, Cochard JF, Cohen Y, Nitenberg G.
Réanimation Médicale, Hôpital Henri Mondor (AP-HP), Av du Maréchal de Lattre de
Tassigny, 94010 Créteil Cedex, France. [email protected]
BACKGROUND: The indication of antiseptic-coated catheters remains debated.
OBJECTIVE: To test the ability of the new generation of chlorhexidine-silver and
sulfadiazine-coated catheters, with enhanced antiseptic coating, to reduce the
risk of central venous catheter (CVC)-related infection in ICU patients. DESIGN:
Multicentre randomized double-blind trial. PATIENTS AND SETTING: A total of 397
patients from 14 ICUs of university hospitals in France. INTERVENTION: Patients
were randomized to receive an antiseptic-coated catheter (ACC) or a standard
non-coated catheter (NCC). MEASUREMENTS: Incidence of CVC-related infection.
RESULTS: Of 367 patients having a successful catheter insertion, 363 were
analysed (175 NCC and 188 ACC). Patients had one (NCC=162, ACC=180) or more
(NCC=13, ACC=11) CVC inserted. The two groups were similar for insertion site
[subclavian (64 vs 69)] or jugular (36 vs 31%)], and type of catheters
(single-lumen 18 vs 18%; double-lumen 82 vs 82%), and mean (median) duration of
catheterisation [12.0+/-11.7 (9) vs 10.5+/-8.8 (8) days in the NCC and ACC
groups, respectively]. Significant colonisation of the catheter occurred in 23
(13.1%) and 7 (3.7%) patients, respectively, in the NCC and ACC groups (11 vs
3.6
per 1000 catheter-days; p=0.01); CVC-related infection (bloodstream infection)
21
occurred in 10 (5) and 4 (3) patients in the NCC and CC groups, respectively
(5.2
vs 2 per 1000 catheter days; p=0.10). CONCLUSIONS: In the context of a low
baseline infection rate, ACC were associated with a significant reduction of
catheter colonisation and a trend to reduction of infection episodes, but not of
bloodstream infection.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Anti-Infective Agents, Local/therapeutic use*
Bacteremia/etiology
Bacteremia/prevention & control*
Catheterization, Central Venous/adverse effects*
Chlorhexidine/therapeutic use*
Double-Blind Method
Equipment Contamination/prevention & control*
France
Humans
Intensive Care Units
Middle Aged
Severity of Illness Index
Silver Sulfadiazine/therapeutic use*
Substances:
Anti-Infective Agents, Local
Silver Sulfadiazine
Chlorhexidine
PMID: 15060765 [PubMed - indexed for MEDLINE]
22: J Pediatr Nurs. 2004 Feb;19(1):74-80.
Erratum in:
J Pediatr Nurs. 2004 Apr;19(2):156.
Chlorhexidine versus povidone-iodine for central venous catheter site care in
children.
Carson SM.
Yuma Regional Medical Center, Yuma, AZ 85364, USA. [email protected]
The number of children receiving central venous catheters (CVCs) for the
administration of medications is at an all-time high. Unfortunately, placement
of
these CVCs is not without risks. Infection of CVC insertion sites is one of the
most common, yet often preventable, causes of nosocomial bacteremia in both
children and adults worldwide. Throughout the years, multiple practice
recommendations have been made regarding the proper site care of CVCs. The most
popular antimicrobial solution used for site care has traditionally been
povidone-iodine. Chlorhexidine gluconate solution, however, has been shown to be
more effective than povidone-iodine in preventing CVC-related infections in
adults. There continues to be controversy regarding the efficacy and safety of
antimicrobial solutions for pediatric CVC site care. An evidence-based approach
was used to determine current recommendations for CVC site care in children.
Publication Types:
Review
22
Mesh Terms:
Anti-Infective Agents, Local/administration & dosage*
Catheterization, Central Venous/nursing*
Child
Chlorhexidine/administration & dosage*
Clinical Competence
Evidence-Based Medicine
Humans
Nursing Methodology Research
Pediatric Nursing*/education
Pediatric Nursing*/standards
Povidone-Iodine/administration & dosage*
Randomized Controlled Trials as Topic
Substances:
Anti-Infective Agents, Local
Povidone-Iodine
Chlorhexidine
PMID: 14963875 [PubMed - indexed for MEDLINE]
23: Intensive Care Med. 2004 Jan;30(1):62-7. Epub 2003 Nov 26.
The pathogenesis of catheter-related bloodstream infection with noncuffed
short-term central venous catheters.
Safdar N, Maki DG.
Section of Infectious Diseases, Department of Medicine, Medical School,
University of Wisconsin, Madison, WI 53792, USA.
OBJECTIVE: Short-term, noncuffed, percutaneously inserted central venous
catheters (CVCs) are widely used and cause more than 250,000 bloodstream
infections (BSIs) in hospitals each year in the United States. We report a
prospective study undertaken to determine the pathogenesis of CVC-related BSI.
DESIGN AND SETTING: Prospective cohort study in a university hospital 24-bed
medical-surgical intensive care unit. PATIENTS AND PARTICIPANTS: Patients
participating in two randomized trials during 1998-2000-one studying the
efficacy
of a 1% chlorhexidine-75% alcohol solution for cutaneous antisepsis and the
other
a novel chlorhexidine-impregnated sponge dressing-formed the study population;
CVC-related BSIs were considered to be extraluminally acquired if concordance
was
identified solely between isolates from catheter segments, skin, and blood
cultures and intraluminally acquired if concordance was demonstrated only
between
hub or infusate and blood culture isolates, as confirmed by DNA subtyping of
isolates from blood and catheter sites or infusate. RESULTS: Of 1,263 catheters
(6075 CVC days) prospectively studied, 35 (2.7%) caused BSI (5.9 per 1000 CVC
days); 27 were caused by coagulase-negative staphylococci. Overall, 45% of
infections were extraluminally acquired, 26% were intraluminally derived, and
the
mechanism of infection was indeterminate in 29%. In the pooled control groups of
the two trials, 25 CVC-related BSIs occurred (7.0 per 1000 CVC days), of which
60% of infections were extraluminally acquired, 12% were intraluminally derived
and 28% were indeterminate. In contrast, CVC-related BSIs in the treatment
groups
were most often intraluminally derived (60%, p=0.006). CONCLUSIONS: Most
catheter-related BSIs with short-term percutaneously inserted, noncuffed CVCs
were extraluminally acquired and derived from the cutaneous microflora.
Strategies achieving successful suppression of cutaneous colonization can
23
substantially reduce the risk of catheter-related BSI with short-term CVCs.
Publication Types:
Research Support, Non-U.S. Gov't
Mesh Terms:
Aged
Antisepsis/methods
Bacteremia/epidemiology
Bacteremia/etiology*
Bacteremia/prevention & control
Bandages
Catheterization, Central Venous/adverse effects*
Catheters, Indwelling/adverse effects*
Chlorhexidine
Cross Infection/epidemiology
Cross Infection/etiology*
Cross Infection/prevention & control
DNA Fingerprinting
DNA, Bacterial/analysis
DNA, Bacterial/genetics
Disinfectants
Equipment Contamination
Equipment Design
Female
Hospitals, University
Humans
Infection Control/methods
Intensive Care Units
Male
Middle Aged
Prospective Studies
Risk Factors
Skin/microbiology
Skin Care/methods
Substances:
DNA, Bacterial
Disinfectants
Chlorhexidine
PMID: 14647886 [PubMed - indexed for MEDLINE]
24: Ann Fr Anesth Reanim. 2003 Nov;22(9):787-97.
Comment in:
Ann Fr Anesth Reanim. 2004 Mar;23(2):164.
[Critical review of the literature concerning the comparative use of two
antiseptic solutions before intravascular or epidural catheterization]
[Article in French]
Clévenot D, Robert S, Debaene B, Mimoz O.
Département d'anesthésie et de réanimation chirurgicale, centre
hospitalo-universitaire La Milétrie, BP 577, 86021 Poitiers, France.
OBJECTIVES: To analyze the most pertinent data from the literature concerning
the
use of an antiseptic solution before the elaboration of invasive procedures such
as blood cultures, insertion of peripheral or central intravenous catheters, and
arterial or epidural catheters, and to identify, if any, the "ideal" antiseptic
24
or, at least, the most efficient. DATA SOURCES: Review of the literature. Data
collected from the Medline database concerning experimental, clinical and basic
research studies published between 1966 and 2003 and a manual research of
references of relevant papers. RESULTS: After a brief historic and
pharmacological reminder, the results of experimental and clinical studies are
presented. Concerning the clinical studies, they concerned almost exclusively
iodine products and chlorhexidine. These comparative studies are classified
according to the punction site and the antiseptic solution used. CONCLUSION:
Even
if the in vitro studies favor iodine products, chlorhexidine in alcoholic
solution seems more efficient than povidone iodine in aqueous solution in the
clinical setting. Several explanations are suggested to understand the in
vitro/in vivo discordances. The place of povidone iodine in alcoholic solution,
whose performances on the healthy skin are similar to those of alcoholic
chlorhexidine, is being in evaluation.
Publication Types:
English Abstract
Review
Mesh Terms:
Alcohols
Anti-Infective Agents, Local*
Biguanides
Catheterization*/adverse effects
Catheterization, Central Venous/adverse effects
Catheterization, Peripheral/adverse effects
Chlorhexidine*
Clinical Trials as Topic
Drug Resistance, Microbial
Drug Utilization
Epidural Space*
Humans
Infection Control/methods*
Iodine Compounds*
Substances:
Alcohols
Anti-Infective Agents, Local
Biguanides
Iodine Compounds
Chlorhexidine
PMID: 14612166 [PubMed - indexed for MEDLINE]
25: Clin Infect Dis. 2003 Sep 15;37(6):764-71. Epub 2003 Aug 27.
Vascular catheter site care: the clinical and economic benefits of chlorhexidine
gluconate compared with povidone iodine.
Chaiyakunapruk N, Veenstra DL, Lipsky BA, Sullivan SD, Saint S.
Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy,
University of Washington, Seattle, WA 98195-7630, USA.
The use of chlorhexidine gluconate solution for vascular catheter insertion site
care reduces the risk of catheter-related bloodstream infection by one-half,
compared with povidone iodine. Our objective was to evaluate the
cost-effectiveness of chlorhexidine gluconate versus povidone iodine. We used
data from randomized, controlled trials, meta-analyses, and epidemiologic
studies
to construct a decision analysis model. We estimated that use of chlorhexidine,
rather than povidone, for central catheter site care resulted in a 1.6% decrease
25
in the incidence of catheter-related bloodstream infection, a 0.23% decrease in
the incidence of death, and savings of 113 dollars per catheter used. For
peripheral catheter site care, the results were similar, although the
differences
were smaller. The results were found to be robust on multivariate sensitivity
analyses. Use of chlorhexidine gluconate in place of the current standard
solution for vascular catheter site care is a simple and cost-effective method
of
improving patient safety in the hospital setting.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Mesh Terms:
Anti-Infective Agents, Local/economics*
Anti-Infective Agents, Local/therapeutic use
Catheterization, Central Venous
Catheters, Indwelling/microbiology*
Chlorhexidine/analogs & derivatives*
Chlorhexidine/economics*
Chlorhexidine/therapeutic use
Cost-Benefit Analysis*
Disinfectants/economics
Disinfectants/therapeutic use
Humans
Outcome and Process Assessment (Health Care)
Povidone-Iodine/economics*
Povidone-Iodine/therapeutic use
Substances:
Anti-Infective Agents, Local
Disinfectants
chlorhexidine gluconate
Povidone-Iodine
Chlorhexidine
Grant Support:
P20-HS11540/HS/United States AHRQ
PMID: 12955636 [PubMed - indexed for MEDLINE]
26: J Hosp Infect. 2003 Aug;54(4):288-93.
A randomized, prospective clinical trial to assess the potential infection risk
associated with the PosiFlow needleless connector.
Casey AL, Worthington T, Lambert PA, Quinn D, Faroqui MH, Elliott TS.
Department of Clinical Microbiology, University Hospital Birmingham NHS Trust,
The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
The microbial contamination rate of luers of central venous catheters (CVCs)
with
either PosiFlow needleless connectors or standard caps attached was
investigated.
The efficacy of 70% (v/v) isopropyl alcohol, 0.5% (w/v) chlorhexidine in
gluconate 70% (v/v) isopropyl alcohol and 10% (w/v) aqueous povidone-iodine to
disinfect the intravenous connections was also assessed. Seventy-seven patients
undergoing cardiac surgery who required a CVC as part of their clinical
management were randomly allocated either needleless connectors or standard
caps.
26
Patients were also designated to receive chlorhexidine/alcohol, isopropyl
alcohol
or povidone-iodine for pre-CVC insertion skin preparation and disinfection of
the
connections. After 72 h in situ the microbial contamination rate of 580 luers,
306 with standard caps and 274 with needleless connectors attached, was
determined. The microbial contamination rate of the external compression seals
of
274 needleless connectors was also assessed to compare the efficacy of the three
disinfectants. The internal surfaces of 55 out of 306 (18%) luers with standard
caps were contaminated with micro-organisms, whilst only 18 out of 274 (6.6%)
luers with needleless connectors were contaminated (P<0.0001). Of those
needleless connectors disinfected with isopropyl alcohol, 69.2% were externally
contaminated with micro-organisms compared with 30.8% disinfected with
chlorhexidine/alcohol (P<0.0001) and 41.6% with povidone-iodine (P<0.0001).
These
results suggest that the use of needleless connectors may reduce the microbial
contamination rate of CVC luers compared with the standard cap. Furthermore,
disinfection of needleless connectors with either chlorhexidine/alcohol or
povidone-iodine significantly reduced external microbial contamination. Both
these strategies may reduce the risk of catheter-related infections acquired via
the intraluminal route.
Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
Mesh Terms:
2-Propanol/therapeutic use
Administration, Cutaneous
Adult
Aged
Aged, 80 and over
Anti-Infective Agents, Local/therapeutic use*
Catheterization, Central Venous/adverse effects*
Catheters, Indwelling/adverse effects*
Chlorhexidine/analogs & derivatives*
Chlorhexidine/therapeutic use
Cross Infection/epidemiology
Cross Infection/etiology
Cross Infection/prevention & control*
Disinfection/methods*
Equipment Contamination/prevention & control*
Equipment Contamination/statistics & numerical data
Equipment Design
Female
Glycerol/therapeutic use
Great Britain/epidemiology
Hospitals, University
Humans
Male
Middle Aged
Povidone-Iodine/therapeutic use
Prospective Studies
Skin Care/methods
Substances:
Anti-Infective Agents, Local
Povidone-Iodine
Chlorhexidine
Glycerol
2-Propanol
27
Hydrex
PMID: 12919759 [PubMed - indexed for MEDLINE]
27: J Am Soc Nephrol. 2003 Jan;14(1):169-79.
Hemodialysis infection prevention with polysporin ointment.
Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J.
University of Toronto, Toronto, Canada. [email protected]
Hemodialysis patients in whom permanent vascular access cannot be achieved are
dependent on a central venous catheter. In such patients, catheter-related
infections are a common and serious complication. This study was a randomized
clinical trial to determine if topical Polysporin Triple antibiotic ointment
applied to the central venous catheter insertion site could reduce the incidence
of catheter-related infections. A total of 169 patients receiving hemodialysis
through a central venous catheter were randomized to receive Polysporin Triple
or
placebo using a double-blind study design. In the 6-mo study period, infections
were observed in more patients in the placebo group than in the Polysporin
Triple
group (34 versus 12%; relative risk, 0.35; 95% CI, 0.18 to 0.68; P = 0.0013).
The
number of infections per 1000 catheter days (4.10 versus 1.02; P < 0.0001) and
the number of bacteremias per 1000 catheter days (2.48 versus 0.63; P = 0.0004)
were also greater in the placebo group. Within the 6-mo study period, there were
13 deaths in the placebo group as compared with 3 deaths in the Polysporin
Triple
group (P = 0.0041). When all available follow-up information was included, the
difference in survival remained significant (19 versus 9 deaths; P = 0.0027).
Within the first 6 mo, infections were observed in 7 of the 13 placebo subjects
who died (54%) as compared with no infections in the three Polysporin Triple
subjects who died. The prophylactic application of topical Polysporin Triple
antibiotic ointment to the central venous catheter insertion site reduced the
rate of infections and was associated with improved survival in hemodialysis
patients.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Administration, Topical
Adult
Aged
Aged, 80 and over
Bacitracin/administration & dosage*
Bacteremia/epidemiology
Bacterial Infections/etiology*
Bacterial Infections/mortality
Bacterial Infections/prevention & control*
Catheters, Indwelling/adverse effects
Double-Blind Method
Drug Combinations
Drug Therapy, Combination/administration & dosage*
Female
Humans
Incidence
Infection Control/methods*
28
Male
Middle Aged
Neomycin/administration & dosage*
Ointments
Polymyxin B/administration & dosage*
Prevalence
Renal Dialysis/adverse effects*
Staphylococcal Infections/epidemiology
Survival Analysis
Substances:
Drug Combinations
Ointments
Neomycin
Polymyxin B
Bacitracin
bacitracin zinc, neomycin sulfate, polymyxin B, drug combination
PMID: 12506149 [PubMed - indexed for MEDLINE]
28: Infection. 2002 Oct;30(5):282-5.
Effect of skin disinfection with octenidine dihydrochloride on insertion site
colonization of intravascular catheters.
Dettenkofer M, Jonas D, Wiechmann C, Rossner R, Frank U, Zentner J, Daschner FD.
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg
University Hospital, Hugstetter Str. 55, D-79106 Freiburg, Germany.
[email protected]
BACKGROUND: We investigated the efficacy of two commercially available,
alcohol-based antiseptic solutions in decontaminating the insertion site of
central lines. One solution contained the bispyridine octenidine
dihydrochloride.
PATIENTS AND METHODS: Inpatients receiving either a central venous catheter
(CVC)
or a peripherally inserted central catheter (PICC) were alternately assigned to
different skin disinfection regimens at the insertion site: (A) 0.1% octendine
dihydrochloride with 30% 1-propanol and 45% 2-propanol, (B) 74% ethanol with 10%
2-propanol. Quantitative skin cultures were obtained from the insertion site at
predetermined intervals. RESULTS: A total of 60 patients received 12 CVCs and 47
PICCs (no significant difference with respect to gender, age and catheter type).
In total, 90 cultures were assessed in each group. The median colony-forming
unit
(cfu) counts per 24 cm(2) (group A vs B) were 2,270 vs 2,950 before, 20 vs 40
following and 860 vs 1,210 24 h after catheter insertion, respectively. A
statistically significant difference in the efficacy of skin decontamination was
seen between groups in culture set (3) and in the difference between culture
sets
(2) and (3) (Wilcoxon rank sum test). CONCLUSION: Octenidine/propanol appears to
be more effective than alcohol (ethanol/propanol) alone in reducing microflora
of
the skin at the PICC/CVC insertion site over a 24-h period.
Publication Types:
Clinical Trial
Comparative Study
Controlled Clinical Trial
Mesh Terms:
1-Propanol/pharmacology*
Anti-Infective Agents, Local/pharmacology*
29
Bacterial Infections/prevention & control
Catheterization, Central Venous/methods
Catheterization, Peripheral/methods
Disinfection/methods*
Drug Therapy, Combination
Equipment Contamination/prevention & control*
Ethanol/pharmacology*
Female
Humans
Male
Middle Aged
Probability
Prospective Studies
Pyridines/pharmacology*
Sensitivity and Specificity
Skin/drug effects
Skin/microbiology
Statistics, Nonparametric
Substances:
Anti-Infective Agents, Local
Pyridines
Ethanol
1-Propanol
octenidine
PMID: 12382087 [PubMed - indexed for MEDLINE]
29: Aust Crit Care. 2002 Aug;15(3):91.
Central line management--progress!
Leslie GD.
Publication Types:
Editorial
Mesh Terms:
Catheterization, Central Venous/adverse effects*
Catheterization, Central Venous/nursing
Chlorhexidine/standards
Critical Care/methods
Disinfectants/standards
Disinfection/methods*
Disinfection/standards
Evidence-Based Medicine
Humans
Infection Control/methods*
Infection Control/standards
Skin Care/methods*
Skin Care/nursing
Skin Care/standards
Substances:
Disinfectants
Chlorhexidine
PMID: 12371380 [PubMed - indexed for MEDLINE]
30: Curr Opin Crit Care. 2002 Oct;8(5):441-8.
Central line infections.
30
Lane RK, Matthay MA.
Department of Internal Medicine, Division of Pulmonary and Critical Care
Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Central venous catheters are commonly used in the critical care setting.
Unfortunately, their use is often associated with complications, including fatal
infections. Making the diagnosis of central venous catheter infection can be
difficult. Additionally, resistance among the more common organisms that cause
catheter-related infection is increasing. However, our understanding of the
pathogenesis of catheter infection is improving through examination of biofilms.
Also, our ability to diagnose catheter-related infections more accurately is
improving with new techniques. There is new hope for ruling out catheter-related
infection before removal by several methods, including a rapid enzyme-linked
immunosorbent assay and the use of time differential for microbial growth
between
blood cultures obtained from a peripheral site and the catheter itself.
Prevention through the use of barrier techniques and antimicrobial-coated
catheters has been demonstrated to be of value in reducing catheter-related
infection with these devices.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
Review
Mesh Terms:
Bacterial Infections/diagnosis
Bacterial Infections/etiology*
Bacterial Infections/prevention & control
Catheterization, Central Venous/adverse effects*
Humans
Infection Control/methods
Silver Sulfadiazine/therapeutic use
Substances:
Silver Sulfadiazine
Grant Support:
R01 HL51856/HL/United States NHLBI
PMID: 12357113 [PubMed - indexed for MEDLINE]
31: Acta Chir Belg. 2002 Aug;102(4):256-8.
What really affects the incidence of central venous catheter-related infections
for short-term catheterization?
Giles Y, Aksoy M, Tezelman S.
Department of General Surgery, Istanbul Medical Faculty, Turkey.
Central venous catheterization is one of the important sepsis reasons in
surgical
patients. In this randomized controlled study, the effect of the frequency and
type of catheter site care, as well as age, coexisting malignancy or diabetes
mellitus, total parenteral nutrition administration and antibiotics use, on
central venous catheter infection was investigated. Seventy-two single-lumen
polyurethane catheters were included. In group I (n: 33), a transparent
occlusive
dressing was applied to the insertion site and not removed for 7 days unless
there were signs of local infection. In group II (n: 39), daily site care was
done with povidone-iodine 10% solution and a new sterile gauze was applied.
Chi-square, linear correlation and multiple regression tests were used for
31
statistical analysis. Mean duration of catheters was 8 +/- 4 days. There was no
catheter-related sepsis. Ten (13.9%) patients had positive catheter tip cultures
of whom three had site infection as well. The incidence of site and tip
infections were not significantly different in group I and II (p > 0.05). Site
infection and age younger than 60 years significantly increased the rate of tip
infection (p: 0.004 and p: 0.02 respectively). Total parenteral nutrition
administration was associated with higher rate of tip infection (p: 0.06).
Coexisting malignancy or diabetes mellitus, duration of catheter and antibiotics
use did not have any significant effect on the rate of central venous catheter
infections (p > 0.05). In conclusion, we observed that the frequency of
insertion
site care and the type of dressing applied to the site had no significant effect
on the rate of CVC infection. Insertion site infection was the most significant
factor increasing the incidence of catheter tip infection. The use of the CVC
for
total parenteral nutrition facilitated tip infection as well.
Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
Mesh Terms:
Adult
Aged
Anti-Infective Agents/therapeutic use*
Antibiotic Prophylaxis*
Bacteremia/epidemiology
Bacteremia/prevention & control
Bacteremia/therapy*
Bacterial Infections/epidemiology
Bacterial Infections/prevention & control
Bacterial Infections/therapy*
Catheterization, Central Venous/adverse effects*
Catheterization, Central Venous/methods*
Chi-Square Distribution
Female
Follow-Up Studies
Humans
Incidence
Iodine/therapeutic use*
Male
Middle Aged
Multivariate Analysis
Occlusive Dressings*
Probability
Prospective Studies
Reference Values
Regression Analysis
Risk Assessment
Time Factors
Treatment Outcome
Substances:
Anti-Infective Agents
Iodine
PMID: 12244905 [PubMed - indexed for MEDLINE]
32: MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.
Guidelines for the prevention of intravascular catheter-related infections.
Centers for Disease Control and Prevention.
32
O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur
H,
McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA.
National Institutes of Health, Bethesda, Maryland, USA.
These guidelines have been developed for practitioners who insert catheters and
for persons responsible for surveillance and control of infections in hospital,
outpatient, and home health-care settings. This report was prepared by a working
group comprising members from professional organizations representing the
disciplines of critical care medicine, infectious diseases, health-care
infection
control, surgery anesthesiology interventional radiology pulmonary medicine,
pediatric medicine, and nursing. The working group was led by the Society of
Critical Care Medicine (SCCM), in collaboration with the Infectious Disease
Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA),
Surgical Infection Society (SIS), American College of Chest Physicians (ACCP),
American Thoracic Society (ATS), American Society of Critical Care
Anesthesiologists (ASCCA), Association for Professionals in Infection Control
and
Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society
(ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American
Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices
Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention
(CDC) and is intended to replace the Guideline for Prevention of Intravascular
Device-Related Infections published in 1996 These guidelines are intended to
provide evidence-based recommendations for preventing catheter-related
infections. Major areas of emphasis include 1) educating and training healthcare
providers who insert and maintain catheters; 2) using maximal sterile barrier
precautions during central venous catheter insertion; 3) using a 2%
chlorhexidine
preparation for skin antisepsis; 4) avoiding routine replacement of central
venous catheters as a strategy to prevent infection; and 5) using
antiseptic/antibiotic impregnated short-term central venous catheters if the
rate
of infection is high despite adherence to other strategies (i.e., education and
training, maximal sterile barrier precautions, and 2% chlorhexidine for skin
antisepsis). These guidelines also identify performance indicators that can be
used locally by health-care institutions or organizations to monitor their
success in implementing these evidence-based recommendations.
Publication Types:
Guideline
Practice Guideline
Mesh Terms:
Adult
Anti-Infective Agents, Local
Antibiotic Prophylaxis
Anticoagulants
Catheterization/standards*
Catheters, Indwelling/adverse effects*
Catheters, Indwelling/microbiology
Catheters, Indwelling/standards*
Child
Equipment Contamination
Humans
Infection/epidemiology
Infection/etiology*
Infection Control/standards*
Risk
33
Substances:
Anti-Infective Agents, Local
Anticoagulants
PMID: 12233868 [PubMed - indexed for MEDLINE]
33: Anaesth Intensive Care. 2002 Jun;30(3):338-40.
Washing of gloved hands in antiseptic solution prior to central venous line
insertion reduces contamination.
Kocent H, Corke C, Alajeel A, Graves S.
Intensive Care Unit, The Geelong Hospital, Barwon Heath, Victoria.
Glove contamination at the time a central venous catheter is handled is highly
undesirable and likely to increase the risk of subsequent line infection. This
study was designed to determine how frequently gloves become contaminated during
central venous line insertion and to demonstrate the value of glove
decontamination immediately prior to handling of the central venous catheter
During twenty routine internal jugular catheter insertions the sterility of the
operator's gloved fingertips (just prior to handling the intravenous catheter)
was assessed by touching the fingertips onto blood agar plates. The gloved hands
were then rinsed in chlorhexidine/alcohol and after drying were placed onto a
further plate. Contamination was detected in 55% of the prewash plates but in
none of the postwash plates. Procedures performed by less experienced resident
staff had a higher contamination rate despite there being no evident breach of
sterile technique. It is likely that glove contamination results from the
persistance of bacteria within the deeper layers of the skin, despite surface
disinfection. These bacteria may be released by manipulation of the skin when
identifying landmarks. This hypothesis was supported by a subsequent observation
that gloves were more highly contaminated after firm touching of the skin rather
than light touching. Glove contamination during central line insertion is
frequent. Catheter contamination rates could be reduced (without risk or
additional cost) by rinsing gloved hands in a solution of chlorhexidine (0.5%)
in
alcohol (70%) prior to handling the catheter.
Publication Types:
Comparative Study
Mesh Terms:
Anti-Infective Agents, Local/pharmacology*
Catheterization, Central Venous/instrumentation*
Colony Count, Microbial
Equipment Contamination/prevention & control*
Gloves, Surgical/microbiology
Handwashing/methods*
Humans
Infection Control/methods
Probability
Prospective Studies
Sensitivity and Specificity
Substances:
Anti-Infective Agents, Local
PMID: 12075642 [PubMed - indexed for MEDLINE]
34: Ann Intern Med. 2002 Jun 4;136(11):792-801.
Comment in:
34
Evid Based Nurs. 2003 Jan;6(1):18.
Summary for patients in:
Ann Intern Med. 2002 Jun 4;136(11):I26.
Chlorhexidine compared with povidone-iodine solution for vascular catheter-site
care: a meta-analysis.
Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S.
Department of Pharmacy Practice, School of Pharmacy, Naresuan University,
Pitsanuloak 65000, Thailand.
PURPOSE: Bloodstream infections related to use of catheters, particularly
central-line catheters, are an important cause of patient morbidity, mortality,
and increased health care costs. This study evaluated the efficacy of skin
disinfection with chlorhexidine gluconate compared with povidone-iodine solution
in preventing catheter-related bloodstream infection. DATA SOURCES: Multiple
computerized databases (1966 to 2001), reference lists of identified articles,
and queries of principal investigators and antiseptic manufacturers. STUDY
SELECTION: Randomized, controlled trials comparing chlorhexidine gluconate with
povidone-iodine solutions for catheter-site care. DATA EXTRACTION: Using a
standardized form, two reviewers abstracted data on study design, patient
population, intervention, and incidence of catheter-related bloodstream
infection
from all included studies. DATA SYNTHESIS: Eight studies involving a total of
4143 catheters met the inclusion criteria. All studies were conducted in a
hospital setting, and various catheter types were used. The summary risk ratio
for catheter-related bloodstream infection was 0.49 (95% CI, 0.28 to 0.88) in
patients whose catheter sites were disinfected with chlorhexidine gluconate
instead of povidone-iodine. Among patients with a central vascular catheter,
chlorhexidine gluconate reduced the risk for catheter-related bloodstream
infection by 49% (risk ratio, 0.51 [CI, 0.27 to 0.97]). CONCLUSIONS: These
results suggest that incidence of bloodstream infections is significantly
reduced
in patients with central vascular lines who receive chlorhexidine gluconate
versus povidone-iodine for insertion-site skin disinfection. Use of
chlorhexidine
gluconate is a simple and effective means of reducing vascular catheter-related
infections.
Publication Types:
Comparative Study
Meta-Analysis
Mesh Terms:
Aged
Anti-Infective Agents, Local/therapeutic use*
Catheterization, Central Venous/adverse effects*
Chlorhexidine/analogs & derivatives*
Chlorhexidine/therapeutic use*
Disinfectants/therapeutic use*
Humans
Middle Aged
Povidone-Iodine/therapeutic use*
Randomized Controlled Trials as Topic
Risk Factors
Sensitivity and Specificity
Sepsis/prevention & control*
Solutions
Substances:
Anti-Infective Agents, Local
35
Disinfectants
Solutions
chlorhexidine gluconate
Povidone-Iodine
Chlorhexidine
PMID: 12044127 [PubMed - indexed for MEDLINE]
35: Pediatrics. 2001 Jun;107(6):1431-6.
Comment in:
Evid Based Nurs. 2002 Jul;5(3):73.
A randomized trial comparing povidone-iodine to a chlorhexidine
gluconate-impregnated dressing for prevention of central venous catheter
infections in neonates.
Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC, Naples M,
Pellegrini J, Buck RK, McAuliffe TL, Goldmann DA, Maki DG.
St. Joseph's Hospital, Milwaukee, WI 53210, USA. [email protected]
Neonates who require a central venous catheter (CVC) for prolonged vascular
access experience high rates of catheter-related bloodstream infection (CRBSI).
PURPOSE: A multicenter randomized clinical trial was undertaken to ascertain the
efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial
Dressing) on the CVC sites of neonates for the prevention of catheter tip
colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting.
Six level III neonatal intensive care units. Patients Studied. Neonates admitted
to study units who would require a CVC for at least 48 hours. METHODS: Eligible
infants were randomized before catheter placement to 1 of the 2 catheter site
antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol
scrub followed by placement of a chlorhexidine-impregnated disk over the
catheter
insertion site. A transparent polyurethane dressing (Bioclusive Transparent
Dressing) was used to cover the insertion site in both study groups. Primary
study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without
an identified source. RESULTS: Seven hundred five neonates were enrolled in the
trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin
disinfection with PI (controls). Neonates randomized to the antimicrobial
dressing group were less likely to have colonized CVC tips than control neonates
(15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5-0.9).
Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5-2.7) and BSI without a source
(15.2% vs 14.3%, RR: 1.1, CI: 0.8-1.5) did not differ between the 2 groups.
Localized contact dermatitis from the antimicrobial dressing, requiring
crossover
into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates
weighing </=1000 g. No neonates in the PI group developed contact dermatitis.
CONCLUSION: The novel chlorhexidine-impregnated dressing, replaced weekly, was
as
effective as cutaneous disinfection with 10% PI and redressing the site every 3
to 7 days for preventing CRBSI and BSI without a source in critically ill
neonates requiring prolonged central venous access. The risk of local contact
dermatitis under the chlorhexidine dressing limits its use in low birth weight
infants who require prolonged central access during the first 2 weeks of life.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
36
Mesh Terms:
Administration, Cutaneous
Administration, Topical
Bacteremia/microbiology
Bacteremia/prevention & control
Bacterial Infections/microbiology
Bacterial Infections/prevention & control*
Bandages*
Catheterization, Central Venous/adverse effects*
Catheters, Indwelling/adverse effects*
Catheters, Indwelling/microbiology
Chlorhexidine/administration & dosage*
Chlorhexidine/therapeutic use
Disinfection/methods
Equipment Contamination/prevention & control*
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Povidone-Iodine/administration & dosage*
Povidone-Iodine/therapeutic use
Treatment Outcome
Substances:
Povidone-Iodine
Chlorhexidine
Grant Support:
MO 1 RR00240/RR/United States NCRR
PMID: 11389271 [PubMed - indexed for MEDLINE]
36: Clin Infect Dis. 2000 Oct;31(4):1001-7. Epub 2000 Oct 25.
Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of
chlorhexidine as cutaneous antisepsis for prevention of central venous catheter
infection.
Humar A, Ostromecki A, Direnfeld J, Marshall JC, Lazar N, Houston PC, Boiteau P,
Conly JM.
Department of Medicine, University Health Network, Toronto General Hospital,
Toronto Western Hospital, and Princess Margaret Hospital, Toronto, Ontario,
Canada.
A multicenter prospective, randomized, controlled trial, with 0.5% tincture of
chlorhexidene versus 10% povidone-iodine as cutaneous antisepsis for central
venous catheter (CVC) insertion, was conducted for patients in intensive care
units. Of 374 patients, 242 had a CVC inserted for >3 days and were used for the
primary analysis. Outcomes included catheter-related bacteremia, significant
catheter colonization (> or = 15 colony-forming units [cfu]), exit-site
infection, serial quantitative exit-site culture (every 72 h), and molecular
subtyping of all isolates. Patients in both study groups were comparable with
respect to age, sex, underlying disease, length of hospitalization, reason for
line insertion, and baseline APACHE II score. Documented catheter-related
bacteremia rates were 4.6 cases per 1000 catheter-days in the chlorhexidine
group
(n=125) and 4.1 cases per 1000 catheter-days in the povidone-iodine group
(n=117;
not significant [NS]). Significant catheter-tip colonization occurred in 24
(27%)
of 88 patients in the povidone-iodine group and in 31 (34%) of 92 patients in
the
37
chlorhexidine group (NS). A mean exit-site colony count of 5.9 x 10(5) cfu/mL
per
25 cm(2) of the surface area of skin in the povidone-iodine group versus 3.1 x
10(5) cfu/mL per 25 cm(2) in the chlorhexidine group (NS) was found. There was a
trend toward fewer exit-site infections in the chlorhexidine group (0 of 125
patients) versus those in the povidone-iodine group (4 of 117 patients; P=.053).
Results of an intention-to-treat analysis were unchanged from the primary
analysis. No difference was demonstrable between 0.5% tincture of chlorhexidine
and 10% povidone-iodine when used for cutaneous antisepsis for CVC insertion in
patients in the intensive care unit.
Publication Types:
Clinical Trial
Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Mesh Terms:
Adult
Aged
Anti-Infective Agents, Local/pharmacology*
Bacteremia/microbiology
Bacteremia/prevention & control*
Catheterization, Central Venous/adverse effects
Catheterization, Central Venous/methods*
Chlorhexidine/pharmacology*
Female
Humans
Intensive Care
Male
Middle Aged
Povidone-Iodine/pharmacology*
Prospective Studies
Substances:
Anti-Infective Agents, Local
Povidone-Iodine
Chlorhexidine
PMID: 11049783 [PubMed - indexed for MEDLINE]
37: Oncol Rep. 2000 Nov-Dec;7(6):1239-42.
A preoperative protocol for the prevention of infection in children with
tunnelled right atrial catheters.
Dawson S, Fitzgerald P, Langer JC, Walton M, Winthrop A, Lau G, Wiernikowski J,
Barr RD.
Children's Hospital, Hamilton Health Sciences Corporation, Hamilton, Ontario L8S
4J9, Canada.
The use of central venous lines has come to be widely accepted by children with
cancer and their families. However, attendant infection is a cause of
considerable morbidity. Coagulase-negative staphylococci, the predominant
aerobic
species on the skin, are now the commonest cause of catheter-related bacteremia.
We introduced a protocol to reduce the colonization of the skin at the catheter
insertion site. Antiseptic skin scrubs, with 4% chlorhexidine gluconate, were
performed on the neck and anterior chest the night before and again on the
morning of the surgical procedure. A single dose of cephalothin (or vancomycin
for penicillin-allergic patients) was administered IV immediately before the
38
operation. Compared to the 12 month period prior to initiation of this protocol,
the rate of infections (occurring within 30 days of catheter placement) in the
3.5 year period of intervention dropped from 8 to 4.9 per 1,000 catheter days.
The proportion of infections that were staphylococcal was reduced from 93 to 63%
and the proportion of non-ports removed within 30 days of placement fell from 45
to 0%. Despite these changes, the major contribution to improved infection
control appeared to be the use of an increased proportion of ports (a rise from
<10 to almost 60%).
Publication Types:
Clinical Trial
Mesh Terms:
Administration, Topical
Adolescent
Anti-Bacterial Agents/therapeutic use
Anti-Infective Agents, Local/therapeutic use
Antibiotic Prophylaxis*
Bacteremia/etiology
Bacteremia/prevention & control
Bacterial Infections/prevention & control*
Catheterization, Central Venous/adverse effects*
Catheterization, Central Venous/methods
Cephalosporins/therapeutic use
Cephalothin/therapeutic use*
Child
Child, Preschool
Chlorhexidine/analogs & derivatives*
Chlorhexidine/therapeutic use*
Female
Humans
Infant
Infant, Newborn
Injections, Intravenous
Male
Skin/microbiology
Staphylococcal Infections/prevention & control
Vancomycin/therapeutic use*
Substances:
Anti-Bacterial Agents
Anti-Infective Agents, Local
Cephalosporins
Vancomycin
Cephalothin
chlorhexidine gluconate
Chlorhexidine
PMID: 11032922 [PubMed - indexed for MEDLINE]
38: Crit Care Med. 2000 May;28(5):1376-82.
The safety of prolonging the use of central venous catheters: a prospective
analysis of the effects of using antiseptic-bonded catheters with daily site
care.
Norwood S, Wilkins HE 3rd, Vallina VL, Fernandez LG, McLarty JW.
East Texas Medical Center, Tyler, USA.
OBJECTIVE: To determine rates of catheter colonization and catheter-related
bloodstream infection (CRBSI) when antiseptic-bonded central venous catheters
(CVCs) and standardized daily site care are used with no predetermined interval
39
for removal. DESIGN: Prospective observational study. SETTING: Two major trauma
centers. PATIENTS: All trauma patients admitted to two major trauma centers that
received a CVC from May 1996 through May 1998. INTERVENTIONS: None. MEASUREMENTS
AND MAIN RESULTS: Catheters were semiquantitatively cultured to identify
bacterial colonization and CRBSI. Monitored variables included total catheter
days, anatomical site of catheter insertion, and area in hospital of catheter
insertion. CVC tips and intracutaneous segments were semiquantitatively
cultured.
A total of 460 (92%) of 501 catheters placed in 324 trauma patients were
evaluable, representing 95.5% of all catheter days during the study period.
Rates
of catheter colonization and CRBSI were 5% (5/1000 catheter days) and 1.5%
(1.511000 catheter days), respectively. Subclavian catheters were in place
longer
than femoral or internal jugular catheters (p < .0001), but the colonization
rate
was significantly lower (p = .03; relative risk, 0.34; 95% confidence interval,
0.15-0.77). No differences in CRBSI rates among anatomical sites or between
catheters used < or =14 days and those used >14 days were identified.
CONCLUSION:
Femoral and internal jugular antiseptic-bonded CVCs develop bacterial
colonization earlier than subclavian CVCs. Subclavian antiseptic-bonded CVCs
combined with standardized daily site care may be safely used >14 days in trauma
patients.
Publication Types:
Comparative Study
Mesh Terms:
Adolescent
Adult
Aged
Anti-Infective Agents, Local*
Bacteremia/microbiology*
Bacteremia/prevention & control
Catheterization, Central Venous/instrumentation*
Chlorhexidine*
Coated Materials, Biocompatible*
Cross Infection/microbiology*
Cross Infection/prevention & control
Equipment Contamination*
Female
Humans
Intensive Care
Male
Middle Aged
Multiple Trauma/microbiology*
Multiple Trauma/therapy
Prospective Studies
Risk Factors
Silver Sulfadiazine*
Substances:
Anti-Infective Agents, Local
Coated Materials, Biocompatible
Silver Sulfadiazine
Chlorhexidine
PMID: 10834681 [PubMed - indexed for MEDLINE]
39: Crit Care Med. 2000 Feb;28(2):366-70.
Evaluation of an antiseptic triple-lumen catheter in an intensive care unit.
40
Hanley EM, Veeder A, Smith T, Drusano G, Currie E, Venezia RA.
Department of Epidemiology, Albany Medical Center Hospital, New York 12208, USA.
OBJECTIVE: To evaluate a decrease in catheter-related bloodstream infection rate
in patients with antiseptic triple-lumen catheters in an intensive care unit.
DATA SOURCES: Retrospective review of surveillance records, patient medical
records, laboratory and microbiological reports, and antibiotic administration
records. STUDY SELECTION: Patients admitted to the intensive care unit with
triple-lumen catheters. DATA EXTRACTION: A subset of one entry per patient was
extracted from 2 yrs of primary bloodstream infection surveillance data. Data
collection included risk factors, laboratory and microbiological data, and
insertion sites and dates of all intravascular catheters present during
triple-lumen catheterization. DATA SYNTHESIS: The catheter-related bloodstream
infection rate was 5.4 and 11.3 per 1000 catheter days in antiseptic and
nonantiseptic triple-lumen catheter groups, respectively (p = .06). By
multivariate analysis using a Cox Proportional Hazards Model, the antiseptic
triple-lumen catheters were associated with a significant reduction in
catheter-related bloodstream infection (p = .03). Model expansion to include
intrajugular site was significant by a likelihood ratio test [2(log likelihood
diff) = 4.26 P<.05 chi2(1)] CONCLUSIONS: The use of antiseptic triple-lumen
catheters may substantially reduce catheter-related bloodstream infections in an
intensive care population and may be subsequently associated with a decrease in
length of stay.
Publication Types:
Research Support, Non-U.S. Gov't
Mesh Terms:
Aged
Analysis of Variance
Anti-Infective Agents, Local*
Catheterization, Central Venous/instrumentation*
Catheters, Indwelling/adverse effects*
Catheters, Indwelling/standards*
Chlorhexidine*
Coated Materials, Biocompatible*
Cross Infection/etiology*
Cross Infection/prevention & control*
Female
Humans
Infection Control/methods
Intensive Care Units
Length of Stay/statistics & numerical data
Likelihood Functions
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Factors
Sepsis/etiology*
Sepsis/prevention & control*
Silver Sulfadiazine*
Survival Analysis
Substances:
Anti-Infective Agents, Local
Coated Materials, Biocompatible
Silver Sulfadiazine
Chlorhexidine
PMID: 10708168 [PubMed - indexed for MEDLINE]
41
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