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|Newsletters: CDC Guidelines on Preventing Catheter-Related Infections|
CDC Guidelines on Preventing Catheter-Related Infections
In 2011, the Centers for Disease Control (CDC) updated their “Guidelines for the Prevention of Intravascular Catheter-Related Infections.” The guidelines, which replace those issued in 2002, were developed for everyone involved in the placement and care of central venous catheters (CVCs) in any setting (i.e., hospital, outpatient, and home). At eighty-three pages, the complete report is obviously too long for us to reprint here. Also, the guidelines cover intravascular catheters used for many purposes (beyond parenteral nutrition) and in all kinds of settings (including the ICU), and only some of the recommendations pertain specifically to home parenteral nutrition (HPN) consumers and caregivers. We have pulled out the recommendations we think would be of most interest to HPN consumers and list them below.
You can use some of these recommendations at home (such as guidelines for care), but we’ve also included some that are directed specifically to health care providers. We hope these will help you as you are faced with decisions or as you talk to your health care providers. Maybe some will raise questions you’d like to bring to your next appointment. Please note that in a few cases, Oley medical reviewers have felt some clarification on how these guidelines apply to homePN consumers is necessary; their comments are noted with asterisks or another symbol (†) and appear at the end of the article and in Table 1.
Note that in providing just a summary of just some of the recommendations, we are omitting a lot of interesting and important information contained in the report, including the background information explaining the “why” behind the recommendations. If you take the opportunity to review the complete report (available on the CDC Web site), please remember that many of the guidelines were developed for use in critical care or are applicable in hemodialysis or with chemotherapy. The needs and circumstances of these patient populations differ from those of the HPN consumer. For example, their length of time with a CVC may be much shorter and thus long-term access may not be an issue; a CVC used for the administration of chemotherapy drugs may not be as susceptible to some infections as a CVC used for nutrient-rich PN; and, of course, what applies in the hospital often doesn’t apply at home. [Editor’s note: For more information on preventing catheter-related infections, check out the Oley Foundation’s free, interactive MY HPN program online.]
IntroductionThe guidelines are intended to provide evidence-based recommendations for preventing intravascular catheter-related bloodstream infections (CRBSIs). They were prepared by a working group led by the Society of Critical Care Medicine (SCCM). Included in the long list of collaborators are the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), the Infusion Nurses Society (INS), and the CDC. Other professional organizations also represent these disciplines, as well as infectious disease, health care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, and pediatric medicine. The guidelines are truly a multidisciplinary effort.
Each recommendation is categorized as follows:
The RecommendationsEducation, Training, and Staffing
Selection of CVC Catheters and Sites
Hand Hygiene and Aseptic Technique
Catheter Site Dressing Regimens
Catheter Securement Devices
Systemic Antibiotic Prophylaxis
Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush, and Catheter Lock Prophylaxis
Replacement of CVCs, Including PICCs
Needleless Intravascular Catheter Systems
Notes from Oley medical reviewers:*This should apply to any nursing unit that deals with CVCs.
** Stat locks [sutureless securement devices] only work with PICCs and Power Hickmans. The device is needed for the life of the PICC and until the Hickman cuff becomes anchored. It cannot be used in a silicone Hickman (which is often the preferred long-term device) because that CVC does not have the adapter molded in the catheter like the PICC and Power Hickman. If you have a tunneled cuffed central line, the stitch should be removed in approximately four weeks since the stitch can promote a local infection.
***A CVC should not be removed if symptoms are mild and it is possible that the CVC is not the source of these symptoms. An infected tunneled CVC can often be treated without removal, but this requires resolution of your fever and negative blood cultures while being treated with antibiotics. If you have a PICC that becomes infected, it will usually need to be removed to treat the infection. For implanted catheters, the specific location of the infection (bloodstream versus the pocket containing the port) will determine whether the catheter will need to be removed. If you have a high fever or are very ill, your doctor may decide to remove your CVC, even before blood cultures are completely processed, as CVC removal is one way to treat an infected CVC. Certain types of infection (for example, fungal) are extremely difficult to clear and typically require catheter removal.
Thanks to the Centers for Disease Control and Oley Trustees, Darlene Kelly, MD, PhD; and Douglas Seidner, MD, for their assistance with this article.
LifelineLetter, January/February 2012