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PEDIATRICS Vol. 110 No. 5 November 2002, pp. e51

ELECTRONIC ARTICLE

Guidelines for the Prevention of Intravascular Catheter-Related Infections

Naomi P. O’Grady, MD*, Mary Alexander, BS{ddagger}, E. Patchen Dellinger, MD§, Julie L. Gerberding, MD, MPH||, Stephen O. Heard, MD, Dennis G. Maki, MD#, Henry Masur, MD*, Rita D. McCormick, RN**, Leonard A. Mermel, DO{ddagger}{ddagger}, Michele L. Pearson, MD§§, Issam I. Raad, MD||||, Adrienne Randolph, MD, MSc¶¶ and Robert A. Weinstein, MD##

* National Institutes of Health, Bethesda, Maryland
{ddagger} Infusion Nurses Society, Cambridge, Massachusetts
§ University of Washington, Seattle, Washington
|| Office of the Director, CDC, Atlanta, Georgia
University of Massachusetts Medical School, Worcester, Massachusetts
# University of Wisconsin Medical School, Madison, Wisconsin
** University of Wisconsin Hospital and Clinics, Madison, Wisconsin
{ddagger}{ddagger} Rhode Island Hospital and Brown University School of Medicine, Providence, Rhode Island
§§ Division of Healthcare Quality Promotion, National Center for Infectious Diseases Centers for Disease Control and Prevention, Atlanta, Georgia
|||| M. D. Anderson Cancer Center, Houston, Texas
¶¶ The Children’s Hospital, Boston, Massachusetts
## Cook County Hospital and Rush Medical College, Chicago, Illinois

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 (ie, 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.

Key Words: catheter-related bloodstream infections • intensive care unit • central venous catheter • peripherally inserted central catheter • guidelines

Abbreviations: CRBSI, catheter-related bloodstream infections • HICPAC, Healthcare Infection Control Practices Advisory Committee • CDC, Centers for Disease Control and Prevention • ICU, intensive care unit • BSI, bloodstream infection • CVC, central venous catheter • PICC, peripherally inserted central catheter • NNIS, National Nosocomial Infection Surveillance • RR, relative risk • CI, confidence interval • IV, intravenous • FDA, US Food and Drug Administration • VRE, vancomycin-resistant enterococcus • VCH, vancomycin/ciprofloxacin/heparin • VH, vancomycin/heparin

Received for publication Mar 8, 2002; Accepted Mar 8, 2002.




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