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Bloodstream Infection Prevention Practices–Reply–I

      We 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. Indeed, strategies that encourage prompt removal or reduce the use of certain devices are important not only for preventing bloodstream infection but also for preventing other types of device-related infection, such as urinary tract infection.
      • Saint S
      • Lipsky BA
      • Goold SD
      Indwelling urinary catheters: a one-point restraint [editorial]?.
      Finally, we too would encourage further research in this area. In addition to surveys, we recommend that this work include a range of methodological approaches, both qualitative and quantitative. For example, although educational efforts can be important, the qualitative work conducted as part of our current study suggests that dedicated staff—specifically PICC (peripherally inserted central catheter) nurses or PICC teams—can play a vital role in identifying and promoting practices to decrease catheter-related bloodstream infections. The importance of issues such as dedicated staff was not readily evident from the data we collected through the survey.

      REFERENCES

        • Saint S
        • Lipsky BA
        • Goold SD
        Indwelling urinary catheters: a one-point restraint [editorial]?.
        Ann Intern Med. 2002; 137: 125-127

      Linked Article

      • Bloodstream Infection Prevention Practices
        Mayo Clinic ProceedingsVol. 82Issue 10
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          To the Editor: We read with interest the enlightening survey of Krein et al1 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.
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