To the Editor: We read with interest the enlightening survey of Krein et al
1
on adherence to the 3 major recommended practices for preventing catheter-related bloodstream infections. In that context, as everyday internists, we also encounter a substantial lack of adherence to other Category 1A recommendations of the CDC.2
Specifically, Krein et al's research does not address recommendations to: (1) periodically assess the knowledge of persons involved with catheter insertion and management, (2) replace administration sets upon suspicion of infection, (3) clean ports with 70% alcohol before access, (4) avoid routine culture of catheter tips, (5) use designated trained personnel for catheter insertion, (6) promptly remove the intravenous line when it is no longer needed, and (7) assess the risks and benefits of insertion. Expensive lines are often used indiscriminately and for prolonged periods to facilitate convenient blood drawing, a consideration that commonly overrides all others in day-to-day practice. Not mentioned in the CDC recommendation is the potential risk and cost associated with a “dedicated lumen policy,” which is in place at many institutions. According to this policy, parenteral nutrition must be administered only through catheter lumens that have not previously been used for other purposes (thus necessitating insertion of a new line if the lumens of an existing line have been used for other purposes).3
We believe that, in addition to the research conducted by Krein et al, it is important to survey for these other, less commonly stressed recommendations. Adherence, if found to be suboptimal, may be improved through aggressive education and policies; for example, the completion of a brief risk-benefit assessment checklist could be required when catheter insertion is contemplated.
REFERENCES
- Use of central venous catheter-related bloodstream infection prevention practices by US hospitals.Mayo Clin Proc. 2007; 82: 672-678
- Guidelines for the prevention of intravascular catheter-related infections.MMWR Recomm Rep. 2002; 51: 1-29
- Dedicated catheter lumens for parenteral nutrition [letter].Clin Infect Dis. 2003; 36: 1625-1626
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© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Bloodstream Infection Prevention Practices–Reply–IMayo Clinic ProceedingsVol. 82Issue 10
- PreviewWe appreciate the interest by Drs Singh and Mehta in our study and agree that many other bloodstream prevention practices warrant attention. We explicitly limited the number of practices included in the survey to avoid overburdening the respondents and to encourage a high response rate. However, we acknowledge that in doing so we excluded other important practices, such as avoiding femoral lines. We agree with Drs Singh and Mehta that the removal of unnecessary catheters is important and that greater attention should be paid to the indications for catheter placement.
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