Guidelines for the Prevention of Intravascular Catheter–Related Infections

TLDR

The working group, led by the Society of Critical Care Medicine in collaboration with IDSA, SHEA, SIS, ACCP, ATS, ASCCA, APIC, INS, ONS, SCVIR, AAP, and CDC’s HICPAC, was formed to replace the 1996 Guideline for Prevention of Intravascular Device–Related Infections. These guidelines are intended to provide evidence‑based recommendations for preventing catheter‑related infections and to guide practitioners who insert catheters and those responsible for infection surveillance and control in hospital, outpatient, and home health‑care settings. The guidelines, developed by a multidisciplinary working group of critical care, infectious disease, infection control, surgery, anesthesiology, interventional radiology, pulmonary, pediatric, and nursing experts, recommend education and training, maximal sterile barrier precautions, 2% chlorhexidine skin antisepsis, avoidance of routine catheter replacement, and use of antiseptic/antibiotic‑impregnated catheters when infection rates remain high, and provide performance indicators for local monitoring.

Abstract

Abstract These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device–Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.