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Vol. 1, No. 2 April 1993 |
Prevention Of Intravenous Line-Related Infection
Intravenous catheters have become an indispensable part of patient care. In the past decade, an increasing number and complexity of types of intravascular devices have been introduced including multiple lumen central catheters and totally implantable devices. Although they offer direct access to the intravascular space, they also provide a potential route for micro-organisms to enter the vascular system by bypassing the normal cutaneous barrier. Line-related infections, including local catheter-related infection, tunnel infections, and bacteraemia, represent the most serious complications which may arise from the use of these devices. The majority of vascular catheter-related infections are caused by endogenous cutaneous microflora which track along the tract of the intravascular device leading to colonization of the catheter tip (1,2). With this knowledge, stratetgies for prevention should be focused on decreasing the numbers of micro-organisms at the catheter exit site.
Mechanisms to protect the catheter exit site in an effort to decrease the risk of catheter-related infection include cutaneous disinfection prior to insertion, application of antiseptics/antimicrobials and application of a sterile dressing. The use and need for cutaneous disinfection prior to insertion is well established but the application of antiseptic/antimicrobial ointments is considered to be of only marginal benefit. Regarding dressing materials, there is now unequivocal evidence about the role of dressing materials influencing the frequency of catheter-related infection. Many institutions enthusiastically endorsed transparent dressing with the argument that they may be changed infrequently and allow continous site inspection. Recent studies (3) comparing standard gauze with transparent dressings have demonstrated a significantly increased risk of catheter-related infection with their use.
Given this finding and the greater expense of transparent dressings, their use as the "standard" dressing for intravascular cannulae can be neither endorsed nor justified. From the standpoint of infection control and risk management, the dressing of choice for the insertion site for intravenous cannulae is standard gauze and tape.
1) Syndman, D.R.; Prober, B.R.; Murray, S.A.; Gorbea, H.F.; Majaka, J.; Perry, L.K. Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection. Lancet 1982; 11: 1185-8.
2) Raad, I.I.; Bodey, P. Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992; 15: 197-210.
3) Hoffman, K.K.; Weber, D.J.; Samsa, G.P.; Rutala, W.A. Transparent poly-urethane film as an intravenous catheter dressing: A meta-analysis of the infection risks. JAMA 1992; 267: 2072-76.
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