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CATHETER-RELATED BLOODSTREAM INFECTIONS

Population

  • Adults and children requiring intravascular catheters.

Recommendations

IDSA 2009, CDC 2011

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

  • Do not place a central venous catheter if peripheral venous access is a safe and effective option.

  • Use an upper extremity site for catheter insertion instead of a lower extremity in adults.

  • Use a midline catheter or peripherally inserted central catheter (PICC) when the duration of IV therapy is likely to exceed 6 d.

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

  • Place nontunneled CVC in the subclavian vein, rather than the internal jugular vein or femoral vein, to minimize infection risk.

  • Use a CVC with the minimum number of ports or lumens essential for management.

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

  • Promptly remove a CVC that is no longer essential.

  • Replace catheters which were placed emergently within 48 h.

  • 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.

  • Avoid antibiotic ointments on insertion sites.

  • Use chlorhexidine-impregnated dressings to protect the insertion site of short-term, nontunneled CVCs only in patients aged 18 y or older.

Sources

COLITIS, CLOSTRIDIUM DIFFICILE

Population

  • Adults and children with no prior history of CDI.

Recommendations

ACG 2013, CID 2018

  • Develop antibiotic stewardship programs to minimize the frequency and duration of high-risk antibiotic therapy.

  • Place patients with suspected CDI preemptively on contact precautions pending the C. difficile test results.

  • Maintain contact precautions for at least 48 h after diarrhea has resolved.

  • Treat patients with CDAD in a private room.

  • Perform hand hygiene before and after contact of a patient with CDI and after removing gloves with either soap or water.

  • Use gloves and gowns on entry to the room of a patient with known or suspected CDI (C. difficile infection) and remove gowns and glovers before leaving the patient’s room.

  • Prevent transmission by using single-use disposable equipment. Thoroughly clean and disinfect reusable medical equipment, preferentially with a sporicidal disinfectant. Dedicated nondisposable equipment should be kept in the patient’s room.

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

  • Although there is an epidemiological association between proton pump inhibitor (PPI) use and CDI, there is insufficient evidence for discontinuation of PPIs as a measure for preventing CDI.

  • Although there is moderate evidence that probiotics containing Lactobacillus rhamnosus GG and Saccharomyces boulardii decrease the incidence of antibiotic-associated diarrhea, there is ...

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