By Robin Varela, RN, BSN, contributor
Roughly 80,000 patients per year develop a CVC (central venous
catheter) line infection while in the intensive care setting. Although exact
numbers for med-surg units are not available, experts estimate that up to
250,000 infections per year occur. Here is what you can do to help prevent CVC infections.
Hand Hygiene: Not only is hand
hygiene important when a catheter is being placed, but it is also critical when
changing dressings, connecting and disconnecting other lines and performing any
other catheter manipulation. Although gloves are always worn, be sure to wash
your hands before and after manipulating a CVC.
Maximal Barrier Protection: When
the CVC is placed, all team members should wear mask, gown, gloves and hair
cover. Cover the patient with a sterile drape. Catheter insertion is the highest
risk event related to infection. Taking these extra steps can help prevent
bacteria in the general environment from contaminating the catheter or site.
Use the Proper Cleansing Agent:
Chlorhexidine gluconate is the preferred antimicrobial agent used for cleaning
CVC sites. Not all facilities have adopted this agent’s use; either use
Chorhexidine gluconate or the facility’s recommended agent. Follow the
guidelines for use closely, so that the potential for infection is kept at a
minimum.
Insertion Site Selection: You may
not be involved in the site selection, but note that the subclavian site is the
preferred site from an infection control perspective. (Other sites may be chosen
for various reasons not related to infection control). The internal jugular (IJ)
site is more difficult to manage since there is more movement in the neck area,
with a greater risk of catheter movement. Dressing at the IJ site also can
become displaced more easily. The femoral site is also more bacteria prone and
there is a greater risk of thrombosis.
Catheter Replacement: Routine
catheter replacement is not recommended to decrease infection rates. Unless
there are signs or symptoms of infection, there is no infection-related reason
to change catheter sites.
Catheter type: Multi-lumen
catheters carry a slightly higher risk of infection when compared to single
lumen catheters. Catheters impregnated with antibacterial agents have a lower
infection rate, and recent analyses of the cost-benefit of these systems
indicate that in certain patient populations the extra cost of the catheter
assists significantly with reducing infection rates. Check with your facility on
the standards for use of these catheters.
Cleansing injection surface:
Regardless of the type of connection that is used to piggy back or add
continuous infusions, the care of the “injection” site is critical. Connection
sites should be cleansed per facility protocol, and lines changed at standard
intervals.
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