> Home > Prevention & Intervention > Mythbusters

SEE IF YOU CAN TELL FACT FROM FICTION. From cost savings to Candida, Clinical Mythbusters tackles questions you face every day. To get Clinical Mythbusters FREE every month, sign up now!

 

 

 

 

<previous>  <next>

 

 

A catheter with chlorhexidine and silver sulfadiazine bonded to its extraluminal and intraluminal surfaces offers complete, comprehensive protection against catheter-related bloodstream infection.

 

False

 

Extra-luminal and intra-luminal contamination are only two of the well-known, documented sources of catheter-related bloodstream infections (CRBSI).

 

In assessing the effectiveness of BioPatch®, Maki et. al. studied 1,263 plain, unprotected catheters.(1) Of these, 35 caused CRBSI: 26 percent of the infections were intraluminally derived; 45 percent were extraluminally derived. The cause of the remaining 29 percent of infections was indeterminate. This alone is a good reason to use a catheter protected on both its extraluminal and intraluminal surfaces.

 

However, this study also supports the notion that to be truly effective, an infection-protection initiative shouldn’t depend on any single tool or technique. Instead, these initiatives must be carried out on multiple fronts, to provide protection in both the near- and long-term against:

 

  • 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.(2)

 

  • Intra-luminal 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.(3)

 

  • Hematogenous seeding—Occurs when bacteria attach to the catheter from a distant site. Antimicrobial catheters impregnated on both surfaces have been shown effective at significantly reducing colonization.(4,5)

 

REFERENCES:

(1) 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.

 

(2) 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 40 th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17–20, 2000, Toronto, Ontario, Canada.

 

(3) Modak SM. Presented as a slide presentation at the 39th ICAAC: San Francisco, CA 1999.

 

(4) 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.

 

(5) 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.

 

ChloraPrep® is a registered trademark of Medi-Flex Hospital Products Corporation.
BioPatch® is a registered trademark of Ethicon, Inc.

 

 

See the full list of mythbusters

Learn what's true and false about catheters and sign up for
our free bulletin on catheters and related subjects

 



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