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CATHETER-RELATED BLOODSTREAM INFECTIONS

Population

  • –Adults and children requiring intravascular catheters.

Recommendations

IDSA 2011, CDC 2011

  • –Educate staff regarding proper procedures for insertion and maintenance of intravascular catheters.

  • –The arm is preferred to the leg for catheter insertion.

  • –Use a central venous catheter (CVC) when the duration of IV therapy is likely to exceed 6 d.

  • –Avoid the femoral vein for central venous access in adult patients.

  • –Subclavian vein is preferred to femoral or internal jugular vein to minimize infection risk for nontunneled CVC.

  • –Use ultrasound guidance to place CVCs to minimize mechanical complications.

  • –Promptly remove a CVC that is no longer essential.

  • –Wash hands before and after catheter insertion, replacement, accessing, or dressing an intravascular catheter.

  • –Use maximal sterile barrier precautions including a cap, mask, sterile gown, sterile gloves, and a sterile full-body drape for the insertion of CVCs.

  • –Chlorhexidine skin antisepsis is preferred to povidone-iodine.

  • –Avoid antibiotic ointments on insertion sites.

Sources

Comment

  1. Clean gloves should be worn when changing the catheter dressings.

COLITIS, CLOSTRIDIUM DIFFICILE

Population

  • –Adults and children taking antibiotics.

Recommendation

Cochrane Database of Systematic Reviews 2013

  • –Use probiotics to prevent C. difficile-associated diarrhea (CDAD) after a course of antibiotics.

Source

  • –Cochrane Collaboration. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. 2013.

Population

  • –Adults and children.

Recommendations

ACG 2013

  • –Develop antibiotic stewardship programs.

  • –Maintain contact precautions until the patient no longer has diarrhea.

  • –Treat patients with CDAD in a private room.

  • –All health care workers and visitors entering the room of a patient known or suspected to have CDAD should observe hand hygiene and barrier precautions, including gloves and gowns.

  • –Prevent transmission by using single-use disposable equipment. Nondisposable medical equipment should be dedicated to the patient’s room and other equipment should be thoroughly cleaned after use.

  • –Disinfect environmental surfaces using an Environmental Protective Agency (EPA)–registered disinfectant with C. difficile sporicidal label claim or 5000 ppm.

  • –Although there is moderate evidence that 2 probiotics (Lactobacillus rhamnosus GG and Saccharomyces boulardii) decrease the incidence of antibiotic-associated diarrhea, there is insufficient evidence that probiotics prevent C. difficile infection.

Source

  • Am J Gastroenterol. 2013;108(4):478.

Comment

  1. Probiotics lower the incidence of CDAD by about 65% after a course of antibiotics.

ENDOCARDITIS PREVENTION

Populations

  • –Endocarditis is more likely a result of random exposure to bacteremia rather than associated with procedures.

  • –Certain ...

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