An estimated 248,000 bloodstream infections occur annually in U.S. hospitals from intravascular catheters. These infections prolong hospital stays by a week on average, increase costs by $35,000-$56,000 per infection, and increase mortality risk by 35%. The risk of catheter-related bloodstream infection is associated with the duration of catheterization, insertion conditions, site care, repeated catheter use, and patient factors like immunosuppression and hypoalbuminemia. The CDC guidelines for prevention emphasize training on insertion and maintenance, maximal sterile barriers during insertion, chlorhexidine skin antisepsis, and avoiding routine catheter replacement.

2. Epidemiology
An estimated 248,000 bloodstream infections occur in
U.S hospitals each year .
Bloodstream infections are usually serious infections
typically causing
.- Prolongation of hospital stay (mean of 7 days)
- Increased cost - estimated attributable cost -
.$35,000 – $56,000
.- Increased risk of mortality (35%)

3. Risk factors for catheter-related bacteremia
1. AJKD 2004, 44(5): 779
2. AJKD 2005, 46(3): 501
3. KI, 2000; 57(5): 2151
• Duration of catheterization
• Conditions for insertion
• Catheter site and catheter site care
• Repeated catheterization
• Increased catheter maniplation
• Tunneled vs nontunnelled catheters
• Immunosuppressive therapy
• Hypoalbuminemia

4. From: Mermel L, Rhode Island Hospital
POTENTIAL ROUTES OF INFECTION

5. Clincal Picture

6. CDC HICPAC
2011 IV Guideline
http://www.cdc.gov/hicpac/pdf/guidelines/
bsi-guidelines-2011.pdf

7. Major areas of emphasis include:
•- Educating and training healthcare personnel who insert and maintain
catheters.
•- Using maximal sterile barrier precautions during central venous catheter
insertion;
•Using a > 0.5% chlorhexidine (CHG) preparation with alcohol for skin
antisepsis;
•Avoiding routine replacement of central venous catheters as a strategy to
prevent Infection
•Using antiseptic antibiotic impregnated short-term central venous catheters
and chlorhexidine impregnated sponge dressings if the rate of infection is not
decreasing despite adherence to other strategies (i.e., education and training,
maximum barrier precautions, and > 0.5% chlorhexidine preparations with
alcohol for skin antisepsis);
http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.
CDC Guidelines for the Prevention of Intravascular Catheter-
Related Infections, 2011

8. Minimize contamination risk by scrubbing the access port with an appropriate
antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and
accessing the port only with sterile devices. Category IA (upgraded from a Category 1B to a 1A)
Replace dressings used on short-term CVC sites every 2 days for gauze dressings,
except in those pediatric patients in which the risk for dislodging the catheter may
outweigh the benefit of changing the dressing. Category IB (changed from 11 to 1B)
Use a fistula or graft instead of a CVC for permanent access for dialysis. Category IA
(changed from a 1B to a 1A)
When adherence to aseptic technique cannot be ensured (i.e., when catheters are
inserted during a medical emergency), replace all catheters as soon as possible and
after no longer than 48 hours. Category 1B (changed from a II to 1B)
CDC IV Guideline: What’s Been Upgraded

14. PREVENTION
IS
BETTER THAN
CURE

15. Prevention of catheter related infection
General measures;
• Every dialysis unit must develop written protocol for
maniplation of hemodialysis catheters and exit-site
dressing technique,
• Hand hygiene before and after patient contact,
• Wear sterile gloves and masks during catheter
procedures,

16. Other methods;
• Elimination of S. Aureus nasal carriage,
• Topical application of different substances,
• Utilize antibiotic-lock technique,
• Usage of different catheters (Are there catheters with
a lower infection rate?)
• impregnated with antimicrobial agents,
• with subcutaneos port,
Prevention of catheter related infection

49. 250 patient with ESKD
8 temporary cathter
5 permi cath
Our unit

55. •Your Patients and their
Families Thank You
•Your Hospital Thank You