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CHAPTER 67: Endocarditis and Other Intravascular Infections 593

TABLE 66-4 Strategies for Prevention of Vascular Device–Related Infections (Continued )
Process or System Preventive Strategy Rationale
Catheter site care Use cutaneous antiseptic for site care at the time of dressing A chlorhexidine-based antiseptic offers the best approach to cutaneous antisepsis considering all criteria for
change use. Povidone-iodine, although effective, is often used improperly despite best efforts to improve compliance
Disinfect catheter hubs, needleless connectors, and injection Reduces the risk of contamination
ports before accessing the catheter
Apply topical antiseptics/antimicrobials at the insertion site Clinical trials to date have shown only marginal or no benefit but may be of benefit in selected
settings, such as hemodialysis catheters
Choose dry gauze or other permeable dressings for site care Less permeable dressings have been associated with both a significantly increased density of flora
at the catheter insertion site and local catheter-related infection rates with some prospective studies
demonstrating a significantly increased risk of catheter-related bacteremia
Catheter care Minimize the number of interruptions to the integrity of the line With TPN there is an increased risk of catheter-related infection with line violations; the system
should be kept closed as much as possible
Delivery system Minimize the number of interruptions to the integrity of the With TPN the risk of catheter-related infections increases significantly with interruptions to the
delivery system integrity of the system
Change administration sets not used for blood, blood products, Changes of the administration sets at 96-hour intervals have not been shown to be associated with
or lipids no longer than every 96 hours any increased risk of catheter-related infection
PICC, peripherally inserted central catheter; TPN, total parenteral nutrition.

as the accompanying rationale for the specific strategy. Comprehensive
guidelines for the prevention of intravascular device–related infections • Ostrosky-Zeichner L, Shoham S, Vazquez J, et al. MSG-01: a random-
ized, double-blind, placebo-controlled trial of caspofungin prophylaxis
are available from the Centers for Disease Control and Prevention. 51
Although new scientific approaches to establishing improved tech- followed by preemptive therapy for invasive candidiasis in high-risk
niques for catheter care are necessary and new technologic advances adults in the critical care setting. Clin Infect Dis. 2014;58:1219-1226.
such as microbe-resistant materials will help reduce the incidence of • O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the
device-related infection, there is no substitute for meticulous care and prevention of intravascular catheter-related infections. MMWR
attention to detail in care of the devices. Recomm Rep. 2002;51:1-26.
• Pronovost P, Needham D, Berenholz S, et al. An intervention to
decrease catheter-related bloodstream infections in the ICU. N
Engl J Med. 2006;355:2725-2732.
KEY REFERENCES
• Ramritu P, Halton K, Collignon P. A systematic review compar-
• Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of ing the relative effectiveness of antimicrobial-coated catheters in
central line-associated bloodstream infections through quality intensive care units. Am J Infect Control. 2008;36:104-117.
improvement interventions: a systematic review and meta- • Ramritu P, Halton K, Cook D, Whitby M, Graves N. Catheter-
analysis. Clin Infect Dis. 2014; Epub ahead PMID 24723276. related bloodstream infections in intensive care units: a systematic
• Cobb DK, High KP, Sawyer RG, et al. A controlled trial of review with meta-analysis. J Adv Nurs. 2008;62:3-21.
scheduled replacement of central venous and pulmonary-artery • Walder B, Pittet D, Tramer M. Prevention of bloodstream infec-
catheters. N Engl J Med. 1992;327:1062-1068. tions with central catheters treated with anti-infective agents
• Digiovine B, Chenoweth C, Watts C, Higgins M. The attributable depends on catheter type and insertion time: evidence from a
mortality and costs of primary nosocomial bloodstream infections in meta-analysis. Infect Control Hosp Epidemiol. 2002;23:748-756.
the intensive care unit. Am J Respir Crit Care Med. 1999;60:976-981.
• Donlan RM. Biofilms and device-associated infections. Emerg
Infect Dis. 2001;7:277-281. REFERENCES
• Edwards J, Peterson K, Banerjee S, et al. National Healthcare Safety Complete references available online at www.mhprofessional.com/hall
Network (NHSN) report: data summary for 2006 through 2008,
issued December 2009. Am J Infect Control. 2009;37:783-805.
• Hockenhull JC, Dwan KM, Smith GW. The clinical effectiveness
of central venous catheters treated with anti-infective agents in CHAPTER Endocarditis and Other
preventing catheter-related bloodstream infections: a systematic
review. Crit Care Med. 2009;37:702-712. 67 Intravascular Infections
• Maki D, Kluger D, Crnich C. The risk of bloodstream infection in Mark B. Carr
adults with different intravascular devices: a systematic review of 200 Kanistha Verma
published prospective studies. Mayo Clin Proc. 2006;81:1159-1171.
• Marschall J, Mermel L, Classen D, et al. Strategies to prevent cen-
tral line–associated bloodstream infections in acute care hospitals. KEY POINTS
Infect Control Hosp Epidemiol. 2008;29:S22-S30. • Intravascular infection should be considered in any critically ill
• Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines patient who has an indwelling intravascular device.
for the diagnosis and management of intravascular catheter-
related infection: 2009 update by the Infectious Diseases Society • Positive blood cultures should always raise the specter of intravas-
of America. Clin Infect Dis. 2009;49:1-45. cular infection.

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