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Per CDC guidelines, if an institution's bloodstream infections don't exceed 3.3 per 1,000 catheter days, there's no reason to use antimicrobial-impregnated catheters.

 

False

 

Antimicrobial-impregnated catheters are vital in the fight against bloodstream infections. But rather than focus on what number of infections merits their use, healthcare institutions should concentrate on eliminating all bloodstream infections by applying every evidence-based tool available. By doing so, institutions can save lives and money.

 

Saving lives
As many as 20 percent of all cases of catheter-related bloodstream infection result in death.(1) However, according to the Institute for Healthcare Improvement’s 100,000 Lives Campaign, institutions should be able to virtually eliminate the causes of bloodstream infections by consistently following protocols that combine basic sanitation, full sterile barrier precautions and the use of proven, evidence-based infection-prevention tools.

 

Antimicrobial catheters can play an important role in this context; their use is strongly recommended and supported by experimental, clinical and epidemiological studies, as well as a strong theoretical rationale.(2)

 

Consider the following example of how antimicrobial catheters can reduce risk by inhibiting colonization of the intraluminal surface. A study by Maki et al. on the effectiveness of BIOPATCH® analyzed 1,263 plain, unprotected catheters.(3) Of these, 35 caused BSI; 26 percent of the infections were intraluminally derived; 45 percent were extraluminally derived. The cause of the remaining 29 percent of infections was indeterminate. An infection-protection initiative carried out on multiple fronts could address all these sources of infection:

 

  • Environmental contamination—Using maximal barrier protection and proper technique reduces the possibility of field and/or catheter contamination.

 

  • Skin flora—The bacterial burden can be reduced drastically by using antiseptics such as BIOPATCH or ChloraPrep®.

 

  • Post-placement subcutaneous tract infection—Despite the use of barrier protection and surface antiseptics, bacteria still gain access to the subcutaneous tract. Chlorhexidine and silver sulfadiazine impregnated into a catheter’s surface “prep” the subcutaneous tract with a burst of antimicrobials at the time of insertion, then continue to have an inhibitory effect in the subcutaneous tract for weeks.(4)

 

  • Intraluminal contamination—Occurs through repeated access into the system and/or breaks in technique during which bacteria gain access to the internal lumens of the catheter. Antimicrobial catheters protected on their intraluminal surface have every lumen protected with chlorhexidine to significantly reduce colonization.

 

  • Hematogenous seeding—Occurs when bacteria attach to the catheter from a distant site. Antimicrobial catheters have been shown effective at significantly reducing colonization of their surface. (5,6)

 

Saving money
Maki et al. also proved conclusively that catheters treated with chlorhexidine and silver sulfadiazine can reduce the incidence of bacteremia by 80 percent,(5) meaning institutions could prevent at least one additional infection (and probably more) per every 100 catheters—and that these catheters would pay for themselves.(7)

Consider this example, based on using an average of 6.8 device days per catheter.(8)

 

Consider this example, based on using an average of 6.8 device days per catheter.(8)

 

Unprotected
Catheter
Antimicrobial-
Impregnated
Catheter
Catheters used per year
500
500
Infections per 1,000 catheter days
3.2
2.9
Cost per infection
$34,508
$34,508
Total infection cost
$375,447
$340,248
Cost per catheter
$60
$73
Total catheters + infections
$405,447
$376,748
Savings using ARROWg+ard®
$28,699

 

 

REFERENCES:

(1) “Getting Started Kit: Prevent Central Line Infections.” The Institute for Healthcare Improvement, 2005, p. 2.

 

(2) O’Grady, N.P., Alexander, M., Dellinger, E.P., Gerberding, J.L., Heard, S.O., Maki, D.G., Masur, H., McCormick, R.D., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A., Weinstein, R.A. “Guidelines for the Prevention of Intravascular Catheter-Related Infections.” The Centers for Disease Control, August 9, 2002, Vol. 51, No. RR10, pp. 7–8.

 

(3) Safdar, N., Maki, D. “The Pathogensis of Catheter-Related Bloodstream Infection With Noncuffed Short-Term Central Venous Catheters.” Intensive Care Medicine, 2004, Vol. 30, pp. 62–67.

 

(4) Fey, P.D., Mathews, K.I., Peterson, D.K., Iwen, P.C., Hinrichs, S.H., Rupp, M.E., “Inhibitory Effect of Explanted Chlorhexidine-Silver Sulfadiazine Impregnated Central Venous Catheters on Staphylococcus Epidermis.” Presented at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17–20, 2000, Toronto, Ontario, Canada.

 

(5) Maki, D.G., Stolz, S.M., Wheeler, S., Mermel, L.A. “Prevention of Central Venous Catheter-Related Bloodstream Infection With an Antiseptic-Impregnated Catheter: A Randomized, Controlled Trial.” Annals of Internal Medicine, August 15, 1997, Vol. 127, Issue 4, pp. 257–266.

 

(6) Rupp, M.E., Lisco, S.J., Lipsett, P.A., Perl, T.M., Keating, K., Civetta, J.M., Mermel, L.A., Lee, D., Dellinger, P.E., Donahue, M., Giles, D., Pfaller, M.A., Maki, D.G., Sherertz, R. “Effect of a Second-Generation Venous Catheter Impregnated With Chlorhexidine and Silver Sulfadiazine on Central Catheter-Related Infections: A Randomized, Controlled Trial.” Annals of Internal Medicine, Vol. 143, No. 8, October 18, 2005, pp. 570–581.

 

(7) Veenstra, D.L., Saint, S., Saha, S., Lumley, T., Sullivan, S.D. “Cost-Effectiveness of Antiseptic-Impregnated Central Venous Catheters for the Prevention of Catheter-Related Bloodstream Infection.” Journal of the American Medical Association, January 20, 1999, Vol. 281, Issue 3, pp. 261–267.

 

(8) Rupp, M.E., et al. “Effect of Chlorhexidine/Silver Sulfadiazine Coating on Microbial Colonization of Central Venous Catheters in a Multicenter Trial.” Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, IL, September 22–25, 2001.

 

Patents: ARROWg+ard®/ARROWg+ard Blue PLUS®: U.S. Patent Nos. 5,019,096; 6,706,024 and 6,872,195.

 

ChloraPrep is a registered trademark of Medi-Flex Hospital Products Corporation.

 

BIOPATCH is a registered trademark of Johnson & Johnson Corporation.

 

 

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Institute of Healthcare Improvement
 5 million lives campaign

The 5 Million Lives Campaign is a voluntary initiative to protect patients from five million incidents of medical harm over the next two years (December 2006 – December 2008).

 

Center for Disease Control and Prevention (CDC)

Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee