Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters

Abstract

reports from the World Health Organization (WHO) and other organizations have identified the increasing endemic burden of health care-associated infections (HAIs) and antimicrobial-resistant infections, which harm patients every day across health care systems in all countries, regardless of income status. Key among the most preventable of these are bloodstream infections (BSIs) and other infections associated with the use of intravascular catheters. Intravascular catheter-associated BSIs and related infections are particularly notable as they are mostly preventable if appropriate precautions and practices for safe insertion, maintenance, access and removal are followed accurately, irrespective of a country’s income level. Intravascular catheters fall broadly into two categories: those that are inserted into peripheral blood vessels (veins and arteries), and those that are inserted into central vessels. Peripherally-inserted catheters are used far more commonly than other intravascular catheters and therefore, require special attention. In particular, peripheral intravenous catheters (PIVCs) are one of the most common invasive devices used in health care facilities, with up to 70% of all inpatients requiring a PIVC at some time during their in-hospital stay. Thus, the global burden of BSIs and other related infections associated with PIVCs is potentially huge. Peripherally-inserted central catheters (PICCs) are also notable. Although used less frequently than PIVCs, the fact that the tip of the catheter is routinely located in a large central vein means that any infection of the PICC is highly likely to quickly result in a serious systemic BSI. Peripheral arterial catheters (PACs) are primarily used in the intensive care unit setting to provide continuous blood pressure monitoring and to readily obtain arterial blood for assessment of oxygenation levels so as to guide appropriate patient ventilation management.