Catheter-related infections, what’s new?

Abstract

Central-vein catheter related infection is the main cause of nosocomial bloodstream infections. It is a severe adverse event accessible to preventive measures. Centralline-associated bacteremia and catheter-related bloodstream infections (CR-BSI) are distinct. CR-BSI rates greater than 1 per 1000 central-vein catheter-days (definition according to the French consensus) are no longer acceptable. In the absence of local signs, severe sepsis, immunosuppression, prosthetic materials, catheters can be maintained safely and peripheral cultures as well as cultures from the catheter blood be performed.

Continuous quality improvement program is feasible in the intensive care unit (ICU), most often effective in decreasing the rate of infection, and important for motivating and structuring the staff. If the basal level of infection is high, simple measures (improvement of hand hygiene, strict surgical aseptic condition at catheter insertion, preferential use of the sub-clavian access, use of alcohol-based disinfectants, procedure for line and dressing maintenance, immediate replacement of moistened, soiled or disrupted dressings, removal of useless catheters) that can be adapted to the ICU uses are effective. Leadership and feedback are key-elements of success of the continuous quality improvement program. If the rate of infection remains high, antiseptic-impregnated dressings are effective in its reduction. Anti-infective-impregnated catheters use should be limited to the failure of the global program.