INDUSTRY INSIGHT

As hospitals look to improve patient outcomes, a lot of attention has been paid to CVC insertions, Catheter Related Blood Stream Infections, and adherence to standard protocols. You can access industry reports that address these, and other, issues which are relevant in today's environment of heightened awareness.

 

Prevention of Catheter-Related Blood Stream Infection: Back to Basics?

Jill R. Cherry-Bukowiec, Krassimir Denchev, Sharon Dickinson, Carol E. Chenoweth, Christy Zalewski, Craig Meldrum, Kristen C. Sihler, Melissa E. Brunsvold, Thomas J. Papadimos, Pauline K. Park, Lena M. Napolitano
Surgical Infections, Volume 12, Number 1, 2011

Conclusion
Elimination of the universal use of Chx-SS-coated CVCs in an SICU with a low number of CR-BSIs did not increase the rate of such infections. This study documents the greater importance of adherence to standardization of the processes of care related to CVC placement and care than of catheter design in reducing CR-BSI.

 

Cost Effectiveness of Antimicrobial Catheters in the Intensive Care Unit:‚Ä® Addressing Uncertainty in the Decision

Kate A Halton, David A Cook, Michael Whitby, David L Paterson, Nicholas Graves
Published: 11 Mar 2009, Critical Care 2009 13:R35

Conclusion
Antimicrobial catheters have been available as a means of preventing CRBSI in the ICU for two decades. Although earlier studies have indicated these devices are cost saving, the findings of this evaluation represent a deeper analysis of the decision than previously available that will help decision makers in any setting considering adopting A-CVCs judge the cost effectiveness of these devices. We have shown that the cost effectiveness of these catheters is uncertain, and are not surprised that infection control decision makers are reticent about using antimicrobial catheters despite the economic evidence. Failure to consider uncertainty generates overly simplistic results and creates skepticism amongst decision makers using them to guide infection control policy. Value of information analyses may suggest where research to reduce this uncertainty should focus, but in the meantime, legislation based on the economics of infection control would do well to consider the complexity of producing good quality evidence in this area.

Key Messages 

  • The cost effectiveness of antimicrobial catheters to prevent catheter-related bloodstream infection in the intensive care unit is highly uncertain.
  • Estimates of cost effectiveness which do not consider uncertainty indicate that minocycline and rifampicin catheters generate the greatest health benefits (1.6 quality-adjusted life years) and opportunity cost savings (AUD $130,289 per 1,000 catheters placed) relative to uncoated catheters.
  • When uncertainty in information currently available to inform this decision is considered, MR-coated catheters return the highest monetary net benefits relative to all other catheter types but there is a 62% probability that this is incorrect.
  • Value of information analyses may suggest where research to reduce uncertainty in this decision should focus to achieve maximum benefit, but in the meantime, decision makers would do well to consider the complexity of producing good quality evidence in this area.

 

What is the Predominant Source of Intravascular Catheter Infections?

Leonard A. Mermel, DO,  Division of Infectious Disease, Rhode Island Hospital
Clinical Infectious Diseases, 2011;52(2):211-212

Conclusion 
In conclusion both extraluminal and intraluminal routes of infection are important in the pathogenesis of central venous catheter-related infections.  Soon after insertion, the extraluminal route of infection predominates, whereas the intraluminal route does so after more extended dwell time.  Thus a focus on catheter insertion will help prevent CRBSI's that occur within days of the catheterization and a focus on catheter maintenance will help prevent later infections. Behavioral changes reflecting education, evidence based catheter insertion, and maintenance bundle use, (13-15), as well as the promise of novel catheter and connector advances (16-17), antimicrobial dressings (18), and catheter flush solutions (19) will further reduce risk of catheter infections.

 

Infection-Thwarting Catheters, Planning Key In Reducing Hospital Deaths

Infection Control Today, Published October 24, 2005
Posted in News, Infection Control Today Magazine, Healthcare, Infections, Healthcare-Acquired Infections (HAIS), Research & Studies,
Surveillance & Epidemiology

Conclusion 
But the study revealed something with even broader implications, Rupp said. It suggested that meticulous infection-control measures used by hospital personnel may have played an even greater role in reducing microbial infections than the catheter itself.

"Our infection rate was much lower possibly because we used good techniques and barriers," Rupp said. "What this means is you don't necessarily have to use coated catheters, you have to use appropriate precautions for inserting and caring for catheters."

The Institute of Medicine contends that wider implementation of the nosocomial infection guidelines from the Centers for Disease Control and Prevention would save more than 40,000 lives annually, reduce infection rates by up to 50 percent, and save nearly $2.75 billion.

Rupp's study was funded by Arrow International Inc., which manufactures the antiseptic-coated catheter. He said investigator-initiated money to study nosocomial infections is nearly non-existent, yet these studies may provide additional proof that simple measures are more successful and far less costly than complex technologies in reducing hospital infections.

 

We Should Implement Process-Based Use of High-Tech Impregnated Central Venous Lines to Prevent Bloodstream Infections

A Joseph Layon, MD, Chief of the Division of Critical Care Medicine, University of Florida College of Medicine
Posted 07/13/2007
From Medscape General Medicine > Departments > Webcast Video Editorials

Conclusion
Pronovost and colleagues[4] showed that an evidence-based, process-centered system of CVL use decreases CRBSI. They used these good practices:[3] hand hygiene, 2% chlorhexidine for skin preparation, full-barrier precautions during CVL insertion, subclavian vein as the preferred site, and removing unnecessary CVLs. They also used a properly stocked central-line supply cart, a checklist of best practices, daily consideration of catheter removal, and feedback regarding the monthly CRBSI number and rates.

After 18 months, and with constant monthly CVL-days, CRBSI rates decreased by 82%, from a baseline mean of 7.7 per 1000 catheter-days (median, 2.7) to 1.4 (with a median of 0).

These huge improvements agree with other published results in adult and pediatric patients,[5] in which best practices were used with progressive decreases of CRBSI.[6]

The CDC suggests use of a "high-tech" catheter if it is to be in place longer than 5 days in a setting of likely high infection rates.[3] It is unclear which antimicrobial/antiseptic catheter to use. One study found lower colonization rates but no differences in CRBSI rates in minocycline/rifampin impregnated, as compared to silver-platinum-carbon, catheters.[7]

We can, and should, approach a zero CRBSI rate by using relatively low-technology techniques, with antimicrobial/antiseptic catheters utilized as needed. The status quo is unacceptable.