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Infection control professionals have until Oct. 22, 2001 to review and submit comments on proposed new guidelines for prevention of intravascular catheter-related infections by the Centers for Disease Control and Prevention. The draft document is available on your free subscriber web site at www.HIConline.com under regulations and guidelines. The document can also be reviewed at www.cdc.gov/ncidod/hip/ivguide.htm. Comments can be submitted via e-mail to firstname.lastname@example.org.
The guideline updates recommendations to reduce the incidence of intravascular catheter-related bloodstream infections. It addresses catheter-related infection, barrier precautions during catheter insertion, skin antisepsis, intervals for replacement of catheters and intravenous fluids and administration sets, catheter site care, the role of specialized intravascular catheter personnel, and the use of antimicrobial/antiseptic impregnated catheters, prophylactic systemic antibiotics, flush solutions, and anticoagulants.
While ICPs should go to the full document for complete recommendations, the general guidance cited below was issued for all intravascular catheters in adult and pediatric patients. The guidelines are ranked according to these categories:
Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies.
Category IB. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale.
Category IC. Required by state or federal regulations, rules, or standards.
Category II. Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale.
I. Health care worker education and training
A. Educate health care workers regarding indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and appropriate infection control measures to prevent intravascular catheter-related infections. Category IA
B. Assess competence and compliance with guidelines periodically for all individuals who insert and manage intravascular catheters. Category IA
C. Ensure appropriate nursing staff-to-patient ratios in ICUs. Category IB
II. Surveillance for catheter-related infection
A. Monitor the catheter sites visually or by palpation through the intact dressing on a regular basis. The frequency of examination will depend on the clinical situation for the individual patient. If the patient has tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or bloodstream infection, the dressing should be removed to allow thorough examination of the site. Category IB
B. Encourage patients to report any changes in their catheter site or any new discomfort to their health care provider.
C. Record the operator, date, and time of catheter insertion and removal, and dressing changes in a standardized location. Category II.
D. Do not routinely culture catheter tips. Category IA.
III. Hand hygiene
A. Observe proper hand hygiene either by washing hands with conventional antiseptic-containing soap and water or with waterless alcohol-based gels or foams. Observe hand hygiene before and after palpating catheter insertion sites, as well as before and after inserting, replacing, or dressing an intravascular catheter. Category IA.
B. Use of gloves does not obviate the need for hand hygiene. Category IA.
IV. Aseptic technique during catheter insertion and care
A. Maintain aseptic technique for the insertion and care of intravascular catheters. Category IA
B. Wear clean or sterile gloves when inserting an intravascular catheter as required by the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. Category IC. Wearing clean gloves is acceptable for the insertion of peripheral intravascular catheters if aseptic technique can be maintained. Sterile gloves must be worn for the insertion of arterial and central catheters. Category IA
C. Wear clean or sterile gloves when changing the dressing on intravascular catheters. Category IC.
[Editor’s note: Written comments on the draft can be submitted to the Resource Center, Attention: IVGuide, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Mailstop E-68, 1600 Clifton Road, N.E., Atlanta, GA 30333. Fax: (404) 498-1244.]
1. Centers for Disease Control and Prevention. Draft Guideline for Prevention of Intravascular Catheter-Related Infections. Fed Reg 2001; 66 :46801.