Systematic Review of Infection Control Literature Relating to Intravascular Devices

Abstract

IVD insertion is the most commonly performed invasive healthcare procedure with approximately 14 million IVDs used in Australia each year (Maki 1992; Australian Bureau of Statistics 2008). Despite their important role in diagnostic and therapeutic care, IVDs are a potential source of healthcare associated infection, the most severe form being IVD-related bloodstream infection (IVD-BSI). About 250,000-500,000 IVD-related BSIs occur each year in the United States alone, and 5,000 cases in Australia. (Collignon 1994; Maki, Kluger et al. 2006; Australian Bureau of Statistics 2008) IVD BSIs are associated with increased mortality, and substantially increase hospital stay and treatment costs by up to 20 days, and US$56,000/episode.(Maki, Kluger et al. 2006) To attempt to prevent these complications, clinicians and researchers have built a significant body of literature and practices. Some of have been tested more or less thoroughly, in a variety of devices. Regular updates to guidelines on prevention of infection in intravascular devices have been published since the 1970s, with more recent years seeing a higher emphasis on evidence-based practice, with more careful assessment of the quality and level of evidence provided by research. There are myriad infection prevention strategies used or recommended in IVD care; it was impossible for this report to cover all of them. Instead, 5 of the major areas of concern to everyday practitioners in the most common line types have been reviewed; skin preparation prior to insertion, barrier precautions during insertion, type and frequency of site dressings, replacement intervals for IVDs, and duration of use for administration sets. For more extensive guidelines covering other interventions, the reader is referred to the 2002 Centers for Disease Control and Prevention (CDC) Guidelines, the 2008 Society of Healthcare Epidemiology of America (SHEA), and the 2009 Infectious Diseases Society of American (IDSA) Guidelines. (O'Grady, Alexander et al. 2002; Marschall, Mermel et al. 2008; Mermel, Allon et al. 2009) It is noted, that the CDC Guidelines are now 7 years old (a new version is expected imminently, but would be expected to be consistent with the IDSA Guidelines), and that the SHEA guidelines focus only on central venous devices. In addition, although these Guidelines cover a larger range of evidence and literature than this review, their inclusion and exclusion criteria after the initial literature search are often not explicit, and different methods of critiquing and attributing levels of evidence are used to that described here.