Prevention of intravascular catheter-related infections

Purpose: To review the literature on prevention of intravascular catheter-r elated infections. Data Sources: The MEDLINE database, conference proceedings, and bibliograph ies of review articles and book chapters were searched for relevant article s. Primary authors were contacted directly if data were incomplete. Study Selection: Studies met the following criteria unless otherwise stated : Trials were prospective and randomized; catheters were inserted into new sites, not into old sites over guidewires; catheter cultures were done by u sing semi-quantitative or quantitative methods; and, for prospective studie s, catheter-related bloodstream infection was confirmed by microbial growth from percutaneously drawn blood cultures that matched catheter cultures. Data Extraction: Data on population, methods, preventive strategy, and outc ome (measured as catheter-related bloodstream infections) were gathered. Th e quality of the data was graded by using preestablished criteria. Data Synthesis: The recommended preventive strategies with the strongest su pportive evidence are full barrier precautions during central venous cathet er insertion; subcutaneous tunneling short-term catheters inserted in the i nternal jugular or femoral veins when catheters are not used for drawing bl ood; contamination shields for pulmonary artery catheters; povidone-iodine ointment applied to insertion sites of hemodialysis catheters; specialized nursing teams caring for patients with short-term peripheral venous cathete rs, especially at institutions with a high incidence of catheter-related in fection; no routine replacement of central venous catheters; antiseptic cha mber-filled hub or hub-protective antiseptic sponge for central venous cath eters; and use of chlorhexidine-silver sulfadiazine-im impregnated or minoc ycline-rifampin-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies that do not inc orporate antimicrobial agents (for example, maximal barrier precautions). Conclusions: Simple interventions can reduce the risk for serious catheter- related infection. Adequately powered randomized trials are needed.