CDC general guidelines for intravascular devices


The Centers for Disease Control and Prevention draft guidelines for intravascular devices divide recommendations into categories based on the available data and epidemiologic studies as follows :

. Category IA. Strongly recommended for all hospitals and strongly supported by well-designed experimental or epidemiologic studies.

. Category IB. Strongly recommended for all hospitals and viewed as effective by experts in the field and a consensus of the Hospital Infection Control Practices Advisory Committee based on strong rationale and suggestive evidence, even though definitive scientific studies may not have been done.

. Category II. Suggested for implementation in many hospitals. Recommendations may be supported by suggestive clinical or epidemiologic studies, a strong theoretical rationale, or definitive studies applicable to some, but not all, hospitals.

. No Recommendation. Unresolved Issue. Practices for which insufficient evidence or consensus regarding efficacy exists.
The following are some of the infection control measures included in the CDC general recommendations for intravascular devices. For more specific guidance, infection control practitioners should consult the CDC draft guidelines.

A. Health Care Worker Education and Training


Conduct on-going education and training of health care workers regarding indications for the use of and procedures for the insertion and maintenance of intravascular devices, and appropriate infection control measures to prevent intravascular device-related infections. (Category IA)

B. Surveillance


1. Conduct surveillance for intravascular device-related infections to determine device-specific infection rates, monitor trends in those rates, and assist in identifying lapses in infection control practices within one's own institution. Express data as the number of catheter-related infections or catheter-related bloodstream infections per 1,000 catheter-days to facilitate comparisons with national trends. (Category IB)

2. Palpate the catheter insertion site for tenderness daily through the intact dressing. (Category IB)

3. Visually inspect the catheter site if the patient develops tenderness at the insertion site, fever without obvious source, or symptoms of local or bloodstream infection. (Category IB)

4. In patients who have large, bulky dressings that prevent palpation or direct visualization of the catheter-insertion site, remove the dressing and visually inspect the catheter site at least daily and apply a new dressing. (Category II)

5. Record the date and time of catheter insertion in a obvious location near the catheter insertion site (e.g., on the dressing or on the bed). (Category IB)

6. Do not routinely perform surveillance cultures of patients or of devices used for intravascular access. (Category IB)`

C.Hand Washing

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Wash hands using an antiseptic-containing product before palpating, inserting, changing, or dressing any intravascular device. (Category II)

D. Barrier Precautions During Catheter Insertion and Care


1. Wear vinyl or latex gloves when inserting an intravascular catheter as required by the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. (Category IB)

2. Wear vinyl or latex gloves when changing the dressings on intravascular catheters. (Category IB)

3. No recommendation for the use of sterile vs. nonsterile gloves during dressing changes. (Unresolved Issue)

E. Catheter Site Care


1. Cutaneous antisepsis and antimicrobial ointments: Cleanse the skin site with an appropriate antiseptic including 70 % alcohol, 10 % povidoneiodine, or 2 % tincture of iodine before catheter insertion. (Category IA)

2. Catheter site dressing regimens: Use either a sterile gauze or transparent dressing to cover the catheter site. (Category IA) Leave dressings in place until the catheter is removed, or changed, or the dressing becomes damp, loosened, or soiled. Change dressings more frequently in diaphoretic patients. (Category IB)

F. Changing Intravenous Catheters and Administration Sets


1. Remove an intravascular device as soon as its use is no longer clinically indicated. (Category IA)

2. Change intravenous tubing, including "piggyback" tubing, no more frequently than at 72-hour intervals, unless clinically indicated. (Category IA)

3. No Recommendation for intravenous tubing changes beyond 72-hour intervals. (Unresolved Issue)

4. Change tubing used to administer blood, blood products, or lipid emulsions within 24 hours of completing the infusion. (Category IB)

Reference
1. Centers for Disease Control and Prevention Draft guideline for prevention of intravascular device-related infections. Fed Reg 60; [187]:49,978-50,006. (Sept 27 1995) .