Device-related infections in critically ill patients. Part I: Prevention of catheter-related bloodstream infections.
Device utilization in critically ill patients is responsible for a high risk of complications such as catheter-related bloodstream infections (CRBSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI). In this article we will review the current status of data regarding CRBSI prevention. General recommendations include staff education and use of a surveillance program with a restrictive antibiotic policy. Adequate time must be allowed for hand washing and barrier precautions must always be used during device manipulation. The routine changing of central catheters is not necessary and increases costs; it is necessary to decrease the handling of administration sets, to use a more careful insertion technique and less frequent set replacement. Antiseptic-coated catheters appear to reduce catheter colonization but their ability to prevent catheter-related infections requires further demonstration. More clinical trials are needed to verify the efficacy of measures to prevent CRBSI.
Section of Anesthesiology and Intensive Care, Department of Critical Care, University of Florence, Florence, Italy. araffaele.degaudio@unifi.it
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D019072:Antibiotic Prophylaxis; D002404:Catheterization / Q000009:adverse effects*; D016638:Critical Illness; D003428:Cross Infection / Q000517:prevention & control; D004866:Equipment Contamination; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control