Chapter 16. Prevention of Intravascular Catheter-Associated Infections

Central venous catheters inserted for short-term use have become common and important devices in caring for hospitalized patients, especially the critically ill. While they have important advantages (eg, ability to administer large volumes of fluid), short-term vascular catheters are also associated with serious complications, the most common of which is infection. Intravascular catheters are one of the most common causes of nosocomial bacteremia; and catheter-related bloodstream infection (CR-BSI) affects over 200,000 patients per year in the United States. This chapter focuses primarily on short-term central venous catheters. Two relatively recent reviews address prevention of infection due to other types of vascular catheters. We review use of maximum barrier precautions (Subchapter 16.1), central venous catheters coated with antibacterial or antiseptic agents (Subchapter 16.2), and use of chlorhexidine gluconate at the insertion site (Subchapter 16.3). We review several promising practices, as well as some common ineffective practices (Subchapter 16.4).