Gepost in: Infecties
Prevention of central venous catheter-related infection in the intensive care unit
In the USA, more than fi ve million patients require central venous access each year. Unfortunately, central venous access can be associated with adverse events that are hazardous to patients and expensive to treat. Infection remains the main complication of intravascular catheters in critically ill patients. Catheter-related bloodstream infections have been reported to occur in 3 to 8% of inserted catheters and are the fi rst cause of nosocomial bloodstream infection in intensive care units (ICUs), with 80,000 cases annually at a cost of $300 million to $2.3 billon . Additional fi nancial costs may be as high as $30,000 per survivor, including one extra week in the ICU and two to three additional weeks in the hospital. Attributable mortality rates range from 0 to 35%, depending on the degree of control for severity of illness. Th e physiopathology of catheter infection is now more clearly understood. Colonization of the endovascular tip of the catheter precedes infection and arises by two main pathways: Th e extraluminal and the intraluminal routes (Fig. 1) . Migration of skin organisms from the insertion site into the cutaneous catheter tract with colonization of the catheter tip is the most common route of infection for short-term central venous catheters (CVCs). For long-term catheters (i.e., catheters staying in place more than 15 days), the main cause of colonization is manipulation of the venous line with migration of organisms along the internal lumen of the catheter. Th e adherence properties of microorganisms to host proteins, such as fi bronectin, commonly present on catheter tips make this colonization easier. Coagulase-negative staphylo cocci are the most common microorganisms associated with catheter-related bloodstream infections. Other microorganisms commonly involved include Staphylococcus aureus, Candida species, Enterococci and Gram-negative bacilli . Th e Centers for Disease Control and Prevention identifi es catheter-associated adverse events, including bloodstream infections, as one of its seven health care safety challenges, with a goal to reduce such compli cations by 50% in fi ve years . Several preventive measures have been studied to reduce the incidence of these infections. Th e most eff ective are those that reduce colonization at the catheter skin insertion site or the infusion line, and include: Adequate knowledge and use of care protocols; qualifi ed personnel involved in catheter changing and care; use of biomaterials that inhibit microorganism growth and adhesion; good hand hygiene; use of an alcoholic formulation of chlorhexidine for skin disinfection and manipulation of the vascular line; preference for the subclavian vein route for insertion of CVCs using full-barrier precautions; and removal of unnecessary catheters.
Denis Frasca, Claire Dahyot-Fizelier, Olivier Mimoz
Frasca et al. Critical Care 2010, 14:212 http://ccforum.com/content/14/2/212