has been thoroughly reviewed in other sources (262). Many innovative approaches to
prevention have been developed including heparin bound catheters, antibiotic lock technique,
and systemic anticoagulation. These are aimed at preventing either fibrin sleeve formation
around the catheter or reducing the risk of bacterial infection of these thrombi. Probably the
most effective of this type of approach is the use of antimicrobial-impregnated catheters (263).
There has not been a large trial supporting the use. Concern still remains regarding the
possibility of allergic reactions to the impregnated material. Use of these devices should
probably be employed only when the rate of CRBSI exceeds 4 per 100,000 catheter days despite
effective of best practice (264–266).
The largest study of preventing CRBSI, to date, was conducted in Michigan. It was based
on 375,000 catheter days involving 103 CCUs of all levels throughout the state. Prevention
consisted of using five procedures; handwashing, full barrier precautions during insertion of
lines, chlorhexidine for skin antisepsis, removal of catheters as soon as possible, and avoidance
of the femoral site of insertion. The use of antibiotic impregnated catheters was not studied.
Applying these interventions for 16 to 18 months, the rate of CRBSI per thousand catheter days
declined from 7.7 to 1.4. In summary, these outstanding results were based on a comprehen-
sive implementation plan combined with consistently focusing on the important interventions.
Success did not necessarily require a dedicated catheter team. Table 26 presents the author’s
opinion of the most important strategies for prevention of infection of intravascular catheters
(264–266).
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Table 26 The Most Effective Strategies for the Prevention of Infection of Intravascular Catheters
Development of a comprehensive prevention strategy
100% compliance with hand washing
Insertion of central catheters under strict sterile conditions
Use of chlorhexidine as skin disinfectant
Avoidance of inserting femoral catheters
No routine replacement of intravenous catheters
Removal of catheters as soon as medically feasible
Use of antibiotic impregnated cathetersa
aUse only under special circumstances (refer to text).
Infective Endocarditis and Its Mimics in Critical Care 249