CDC issues new guidance on catheter-linked blood infections

Apr 1, 2011 (CIDRAP News) – Federal health officials today released a lengthy set of new guidelines for preventing bloodstream infections in patients with intravenous catheters, a problem that's estimated to cost the nation billions of dollars a year.

The 83-page document, titled "Guidelines for the Prevention of Intravascular Catheter-Related Infections," marks the first revision of the guidelines since 2002. It was released by the Centers for Disease Control and Prevention (CDC).

"The updated CDC guidelines are rich with new recommendations that are based on additional scientific research that has emerged since the prior version was published," said Russell N. Olmsted, MPH, CIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC), one of the medical organizations that helped write the guidelines.

'Perfect timing'
"The timing for this updated guideline is perfect because starting this year hospitals that accept Medicare patients are required to report their central line-associated bloodstream infections to the Centers for Medicare & Medicaid Services, or risk losing 2% of their Medicare payments," Olmsted commented in an APIC press release.

The guidelines are intended for healthcare personnel who insert intravascular (IV) catheters and those responsible for monitoring and controlling infections in hospitals, outpatient clinics, and home healthcare, APIC noted.

The new document says that about 80,000 catheter-related bloodstream infections (CRBSIs) occur each year in US hospital intensive care units, and the overall total of bloodstream infections in hospitals is estimated at 250,000.

The guidelines emphasize five main strategies:

  • Educating and training healthcare personnel who insert and maintain catheters
  • Using maximal sterile barrier precautions during central venous catheter (CVC) insertion
  • Using a skin preparation of more than 0.5% chlorhexidine with alcohol for antisepsis
  • Avoiding routine replacement of CVCs as a strategy to prevent infection
  • Using antiseptic- or antibiotic-impregnated short-term CVCs and chlorhexidine-impregnated sponge dressings if the rate of infection is not decreasing despite the use of other recommended strategies

The guidelines were prepared by a working group led by the Society of Critical Care Medicine and involving a long list of other medical societies along with the CDC and its Healthcare Infection Control Practices Advisory Committee. Among the organizations involved were APIC, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America (SHEA), and the Pediatric Infectious Diseases Society, along with a number of other physician and nursing associations.

Reducing bloodstream infections in kids
In other developments, a study by researchers at Johns Hopkins Children's Center indicated that hospitals can reduce the risk of life-threatening bloodstream infections in children with peripherally inserted CVCs by assessing the patient's progress daily and removing the device as early as possible, according to a Johns Hopkins press release. The findings are to be presented tomorrow at the SHEA annual meeting.

The authors analyzed predictors of catheter-related bloodstream infections among 1,800 children treated at Hopkins over 6 years. The children cumulatively underwent more than 2,590 catheter insertions, which resulted in a total of 116 infections.

One important predictor of infection was length of use, the researchers found. Children whose devices remained in for 3 weeks or longer were 53% more likely to get a bloodstream infection, compared with those with shorter catheter times. Children whose catheters were for receiving IV nutrition were more than twice as likely to get an infection as children who had the devices placed for other reasons.

Senior author Aaron Milstone, MD, MHS, commented in the release, "Clinicians should evaluate each patient's condition daily and weigh the risk of leaving the device in against the risk of removing it by asking a simple question 'Does this child need a central line for another day?'"

See also:

New CDC guidelines for preventing IV catheter-related infections

Apr 1 APIC press release

May 27, 2010, CIDRAP News story "CDC reports drop in healthcare-related blood infections"

Mar 31 Johns Hopkins press release

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