title: Improved sterile technique diminishes the incidence of positive line cultures in cardiovascular patients.
abstract: In order to determine the incidence of positive line cultures, especially as affected by differing protocols for line insertion, cultures were obtained from lines in residence for up to 4 days from cardiac patients (who received Cefuroxime) and vascular patients (who received Cefazolin) as prophylaxis perioperatively. Positive cultures were obtained from 95 (19%) of 496 lines in cardiac patients and 83 (31%) of 261 lines in vascular patients. There was a linear relationship between duration of line residence and the incidence of positive line cultures, increasing from 14% on Day 1 to 33% on Day 4. The use of full sterile technique at the time of insertion halved the incidence of subsequent positive line cultures. Four of the 403 (1%) patients each had a single episode of postoperative line sepsis. Another four patients developed wound infections with the same organisms as cultured from their lines. One patient has had a vascular graft infection with the same organism cultured as was isolated from a Swan-Ganz line 1 year previously. These data suggest that monitoring lines should be inserted using full sterile technique and removed as soon as the patient is hemodynamically stable.
authors.affiliation: Surgical Service, Tucson VA Medical Center, Arizona.
authors.forename: D A
authors.initials: DA
authors.lastname: Bull
authors.forename: L A
authors.initials: LA
authors.lastname: Neumayer
authors.forename: G C
authors.initials: GC
authors.lastname: Hunter
authors.forename: G K
authors.initials: GK
authors.lastname: Sethi
authors.forename: K E
authors.initials: KE
authors.lastname: McIntyre
authors.forename: V M
authors.initials: VM
authors.lastname: Bernhard
authors.forename: C W
authors.initials: CW
authors.lastname: Putnam
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D013203:Staphylococcal Infections / Q000517:prevention & control; D013212:Staphylococcus epidermidis; D013242:Sterilization / Q000379:methods*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control