PMID- 10378561
OWN - NLM
STAT- MEDLINE
DCOM- 19990708
LR  - 20190514
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 115
IP  - 6
DP  - 1999 Jun
TI  - Decreasing catheter colonization through the use of an antiseptic-impregnated 
      catheter: a continuous quality improvement project.
PG  - 1632-40
AB  - STUDY OBJECTIVES: To evaluate the use of an antiseptic-impregnated (chlorhexidine 
      and silver sulfadiazine) catheter for the prevention of catheter colonization and 
      catheter-related bloodstream infection (CR-BSI). Then, based on these findings, 
      to implement changes in hospital policy and to assess their effect on a hospital 
      service. DESIGN: Prospective, randomized, controlled (phase I); prospective, 
      concurrent data collection (phase II). SETTING: Tertiary referral hospital with 
      level 1 trauma center. PATIENTS: Patients > 12 years of age with central venous 
      catheters placed while they were in the emergency room, neurotrauma ICU, or 
      medical/surgical ICU from May through December, 1995 (phase I). All patients > 12 
      years of age on the trauma service admitted from November 16, 1996, through 
      November 15, 1997 (phase II). INTERVENTIONS: Randomization table determined 
      whether the patient would receive an antiseptic-impregnated catheter (AIC) or 
      nonimpregnated catheter (NIC) (phase I). All removed or exchanged catheters were 
      sent for semiquantitative culture. In phase II, only AICs were used; "length of 
      time" and "fever" were discouraged as reasons for catheter exchange or removal; 
      and only the tip was sent for culture. MEASUREMENTS AND RESULTS: In phase I, 
      there were 139 catheters placed in 60 patients in the NIC group and 98 catheters 
      placed in 55 patients in the AIC group. Two catheters (2.0/100 catheters) in the 
      AIC group were found to be colonized, compared with 25 (18.0/100 catheters) in 
      the NIC group (p = 0.001). The catheter colonization rates were 2.27/1,000 
      catheter days (AIC) and 24.68/1,000 catheter days (NIC) (p < 0.001), while the 
      CR-BSI rates were 1.14/1,000 catheter days (AIC) and 3.9.5/1,000 catheter days 
      (NIC) (p = 0.31). The reason for each catheter removal/exchange was noted, and 
      only "positive blood culture" was statistically significant overall. The tip 
      segment was found to be positive more often than the intracutaneous segment. In 
      phase II, there were 213 AICs placed in 101 patients. The colonization rate was 
      3.8/100 catheters (4.52/1,000 catheter days), and CR-BSI rate was 1.0/100 
      catheters (0.6/1,000 catheter days). The colonization rate for catheters left in 
      place remained low for catheters left in place < 14 days (1.6/100 catheters). 
      Only 11% of catheters were exchanged/removed for reason of "fever," as compared 
      with 23% in phase I. CONCLUSIONS: AICs significantly reduce the rate of central 
      venous catheter colonization. In addition, the apparent protective effects of the 
      catheter over time permit less frequent exchanges or removals of the catheters, 
      decreasing both patient risk and hospital cost.
FAU - Collin, G R
AU  - Collin GR
AD  - Department of Medical Education, Carilion Roanoke Memorial Hospital, Roanoke, VA 
      24033, USA.
LA  - eng
PT  - Clinical Trial
PT  - Clinical Trial, Phase I
PT  - Clinical Trial, Phase II
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anti-Infective Agents, Local)
RN  - 0 (Coated Materials, Biocompatible)
RN  - R4KO0DY52L (Chlorhexidine)
RN  - W46JY43EJR (Silver Sulfadiazine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anti-Infective Agents, Local/*therapeutic use
MH  - Bacteremia/prevention & control
MH  - Bacteria/*isolation & purification
MH  - Catheterization, Central Venous/*instrumentation
MH  - Catheters, Indwelling/*microbiology
MH  - Child
MH  - Chlorhexidine/therapeutic use
MH  - Coated Materials, Biocompatible/*therapeutic use
MH  - Colony Count, Microbial
MH  - Equipment Contamination/*prevention & control
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Prosthesis-Related Infections/microbiology/*prevention & control
MH  - Silver Sulfadiazine/therapeutic use
EDAT- 1999/06/23 00:00
MHDA- 1999/06/23 00:01
CRDT- 1999/06/23 00:00
PHST- 1999/06/23 00:00 [pubmed]
PHST- 1999/06/23 00:01 [medline]
PHST- 1999/06/23 00:00 [entrez]
AID - S0012-3692(15)38301-X [pii]
AID - 10.1378/chest.115.6.1632 [doi]
PST - ppublish
SO  - Chest. 1999 Jun;115(6):1632-40. doi: 10.1378/chest.115.6.1632.