Intravascular catheter-related infections

Correlation of Intra Vascular Cannula Insertion Technique and Ward Practices with Local Site Infection

BACKGROUND

Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.

METHODS

The study was carried out in the wards of a tertiary care hospital. The study was divided into two phases, each phase comprising of 50 patients. In phase 1, cannula insertion was carried out after normal ward cleaning practices. In phase 2, cleaning of the site was done by standard surgical cleaning procedure. The cannula samples after removal were cultured and local signs of thrombophlebitis looked for at the site of insertion. Thrombophlebitis was considered a surrogate marker of local infection in the vessel wall.

RESULT

The relative risk of acquiring thrombophlebitis increased by 2.18 times (applying univariate analysis) by existing methods as compared to the standard method.

CONCLUSION

Use of standard cleaning protocol had a significant effect on decreasing the incidence of cannula associated infections and cannula related morbidity.

Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters

OBJECTIVE

Peripheral arterial catheters are perceived as having low infective potential compared with other catheters and may be overlooked as a cause of catheter-related bloodstream infection. We aimed to measure colonization and rates of catheter-related bloodstream infection in arterial catheters, to investigate risk factors for arterial catheter colonization, and to compare arterial catheter infection rates with those in concurrently sited and managed central venous catheters.

DESIGN

Prospective 24-month cohort study.

SETTING

Eight-bed combined general intensive care and high-dependency unit of a 350-bed Australian teaching hospital.

PATIENTS

Three hundred twenty-one arterial catheters in 252 adult and pediatric patients were observed for 1,082 catheter days, and 618 central venous catheters in 410 patients were observed for 4,040 catheter days. All catheters were inserted in, or presented to, the intensive care unit. Both arterial catheters and central venous catheters were inserted by trained personnel under aseptic conditions, and management was standardized.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The incidence per 1,000 (95% confidence interval) catheter days of colonization (> or = 15 colonies) and catheter-related bloodstream infection was 15.7 (9.5-25.9) and 0.92 (0.13-6.44) for arterial catheters and 16.8 (13.3-21.3) and 2.23 (1.12-4.44) for central venous catheters. Arterial catheter colonization was not significantly different than that in central venous catheters (hazard ratio, 1.17; 95% confidence interval, 0.41-3.36; p = .77). Arterial catheter colonization increased with dwell time and was similar to central venous catheters over time. Femoral arterial catheters were colonized more often than radial arterial catheters (hazard ratio, 5.08; 95% confidence interval, 0.85, 30.3; p = .075), and colonization was significantly higher when the catheter was inserted in the operating theater or emergency department (hazard ratio, 4.45; 95% confidence interval, 1.42-13.9; p = .01) compared with the intensive care unit.

CONCLUSIONS

The incidence of catheter-related bloodstream infection from arterial catheters was low. However, both arterial catheter colonization and rates of catheter-related bloodstream infection were similar to those in concurrently sited and identically managed central venous catheters. By inference, the arterial catheter should be accorded the same degree of importance as the central venous catheter as a potential source of sepsis.

Postoperative Fever

BACKGROUND

Fever is common in surgical patients. The list of potential causes is long and includes many noninfective etiologies.

CAUSES

Only about 40% of fever episodes in hospitalized patients are caused by infection. Any fever in a surgical patient is a cause for concern. New or continuing fever more than three days after surgery should raise a strong suspicion of persistent illness or a new complication. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including acute cholecystitis, antibiotic-related pseudomembranous colitis, systemic candidiasis, or transfusion-related cytomegalovirus disease. A change in the microbiology of postoperative infections has also been noticed, characterized by a greater incidence of infections caused by methicillin-resistant Staphylococcus aureus, by polymicrobial flora, and by fungi.

TREATMENT

Control of nosocomial infections has become more challenging recently because of widespread bacterial resistance to antibiotics and to more frequent surgical indications in elderly patients at higher risk. Early recognition and appropriate treatment of these infections relieves anxiety, reduces hospital costs, and increases patient survival rates.

CONCLUSIONS

The workup and therapy for the individual patient may differ, depending on the underlying disease and clinical appearance and the clinician's suspicion for infection. Subsequent testing should be based on the clinical findings. Perhaps more money is wasted in the evaluation of early postoperative fever than on any other aspect of postoperative care.

The Effect of Nursing Interventions on Catheter-related Bloodstream Infections in Patients Receiving Total Parenteral Nutrition Through Peripherally Inserted Central Catheter Lines

Background: Catheter-related blood-stream infection (CRBSI) is a serious and costly complication associated with central venous catheters. Nursing interventions that focus on decreasing bacterial colonization at the insertion site could decrease infection rates. Method: This retrospective study examined CRBSI in patients requiring peripherally inserted central catheters (PICCs) for total parenteral nutrition. One hundred and ninety-two patients with 235 catheters and an average dwell time of 11.5 days participated. Nursing interventions included a chlorhexidine-impregnated sponge dressing and a double skin scrub prior to insertion. Conclusion: The results of the study show that the interventions did not reduce CRBSI in the target population but the double skin scrub did decrease CRBSI in the general PICC population.