In many hospitals, the only sterile precautions used during the insertion of a nontunneled central venous catheter are sterile gloves and small sterile drapes. We investigated whether the use of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, and large drape) would lower the risk of acquiring catheter-related infections.

Prospective randomized trial.

A 500-bed cancer referral center.

We randomized patients to have their nontunneled central catheter inserted under maximal sterile barrier precautions or control precautions (sterile gloves and small drape only). All patients were followed for 3 months postinsertion or until the catheter was removed, whichever came first. Catheter-related infections were diagnosed by quantitative catheter cultures and/or simultaneous quantitative blood cultures.

The 176 patients whose catheters were inserted by using maximal sterile barrier precautions were comparable to the 167 control patients in underlying disease, degree of immuno-suppression, therapeutic interventions, and catheter risk factors for infections (duration and site of catheterization, number of catheter lumen, catheter insertion difficulty, reason for catheter removal). There were a total of four catheter infections in the test group and 12 in the control group (P=0.03, chi-square test). The catheter-related septicemia rate was 6.3 times higher in the control group (P=0.06, Fisher's exact test). Most (67%) of the catheter infections in the control group occurred during the first 2 months after insertion, whereas 25% of the catheter infections in the maximal sterile precautions group occurred during the same period (P<0.01, Fisher's exact test). Cost-benefit analysis showed the use of such precautions to be highly cost-effective.

Maximal sterile barrier precautions during the insertion of nontunneled catheters reduce the risk of catheter infection. This practice is cost-effective and is consistent with the practice of universal precautions during an invasive procedure.

To evaluate the efficacy of an educational program for the prevention of catheter colonization.

Two cross-sectional studies were carried out in a 500-bed randomly selected area of the hospital, separated by an educational program on the care of intravenous lines based on the Centers for Disease Control and Prevention (CDC) recommendations for the control of catheter-related infections.

A 2,100-bed urban general hospital affiliated with the University of Madrid (Spain).

Characteristics of patients and catheters and appropriateness of catheter care were evaluated. Cultures were taken from the point of insertion of the vascular catheter, the hubs, and infusion fluids. When catheter-associated infection was suspected, the distal end of the catheter was sent for culture and two blood cultures were taken. We compared the clinical and microbiological data before and after carrying out an educational program based on CDC recommendations for the control of catheter-related infections.

Characteristics of patients and catheters did not differ between the two cross-sectional studies. Compared with baseline data, after the educational program we observed a reduction of inappropriate catheter care, from 83% to 38% (45% difference, 95% confidence interval [CI95], 55% to 35%, P<0.0000), and a reduction in the rate of skin colonization, from 34% to 18% (16% difference, CI95, 26% to 5%, P<0.001). The frequency of phlebitis (15% versus 14%), hub colonizations (12% versus 11%), catheter colonizations (2% versus 1%), and catheter-related bacteremias (0% versus 0%) remained unchanged between the two cross-sectional studies.

Our educational program improved catheter care and reduced significantly the proportion of skin colonization around the insertion point. However, the educational program did not modify the proportion of hub colonization; because hub colonization has been demonstrated to be a source of line sepsis, our data suggest the need for a specific program directed to the maintenance of catheter hubs.

Develop national estimates of compliance with infection control guidelines by workers in healthcare facilities to prevent occupational transmission of hepatitis B virus (HBV) and human immunodeficiency virus.

A national survey of 3,094 workers in hospitals.

United States ambulatory care hospitals with emergency rooms.

While the sampled hospitals had policies that incorporated the Centers for Disease Control and Prevention's (CDC) infection control guidelines, only 55% of patient care staff, 56% of physicians, and 30% of housekeeping staffreported receiving at least one of the shots recommended in the HBV vaccination series. About one half of patient care staff reported that they recapped used needles at least sometimes after giving injections and after drawing blood. Only 43% of patient care staff “always” wore gloves to draw blood. While most patient care staff “always” changed gloves between patients, only 61% reported that they “always” washed their hands after taking off their gloves. One half of patient care staff reported a percutaneous exposure to a patient's blood, and one quarter reported a percutaneous exposure in the past year The most common cause of these exposures was recapping used needles.

Efforts to reduce exposures to bloodborne pathogens will involve compliance with the Occupational Safety and Health Administration bloodborne pathogens standard and the CDC's infection control guidelines, continued education and training, and emphasis on engineering controls where applicable.

To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization.

Prospective multicenter cohort study.

Two university teaching hospitals and five large nonteaching hospitals.

Patients admitted to intensive care units or surgical units and exposed to short-term CVCs.

Of 623 catheterization episodes, 9.3% were associated with catheter-related infections (CRI). The skin at the catheter site was frequently colonized (16.2%) and was the potential source of infection in 56.1% of the cases, mostly local infections. The hub was colonized less frequently (3.5%) but was responsible for systemic infections more frequently

The following variables were independently associated with CRI: duration of catheterization (for 7 to 14 days, odds ratio [OR], 3.9; 95% confidence interval [CI]95, 1.4 to 10.7; and for >14 days, OR, 5.1; CI95, 1.7 to 15.4), coronary care unit service (OR, 6.7; CI95, 1.1 to 42.9) or surgery service (OR, 4.4; CI95, 1.03 to 18.5), second episode of catheterization (OR, 7.6; CI95, 1.8 to 32.3), skin colonization at the insertion site (OR, 56.5; CI95, 10.8 to 296), and hub colonization (OR, 17.9; CI95, 2.4 to 132).

The risk associated with skin colonization varied with use of jugular access or simultaneous colonization of the hub. When only symptomatic CRI was considered, the risk associated with hub colonization was consistently higher (OR, 36.6; 7 to 190) than that associated with skin colonization (OR, 3.2; CI95, 0.7 to 14).

Age, transparent dressing, jugular insertion, male gender, duration of catheterization, and hub colonization were independent risk factors for skin colonization. The effect of age varied by type of dressing and vice versa; the effect of jugular access varied by sex; and the effect of transparent dressing varied by length of catheter-ization and vice versa.

Total parenteral nutrition and skin colonization were independently associated with an increased risk of hub colonization.

Skin and hub colonization are the two major determinants for endemic CRIs; colonization of the hub, however, is more frequently associated with more severe infections. In order to reduce CRIs, more efforts should be focused on understanding which factors increase the risk of colonization both of the skin and of the hub.