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Intensive Care Medicine

, Volume 42, Issue 11, pp 1784–1786 | Cite as

What’s new in catheter-related infection: skin cleansing and skin antisepsis

  • Olivier Mimoz
  • Vineet Chopra
  • Jean-François Timsit
What's New in Intensive Care
Catheter-related infections (CRIs) are common, life-threatening healthcare-associated infections in intensive care unit (ICU) patients. Accumulating evidence suggests that the incidence of these infections can be decreased through discrete processes of care (Table  1) [ 1]. Because microorganisms from the skin at the site of catheter insertion are often the source of CRI [ 2], optimal skin preparation prior to short-term catheter placement is an example of such a discrete process.
Table 1

Basic bundle to prevent catheter-related infection

Use written protocol for catheter insertion and maintenance

Rub hands with alcohol-based solutions before each line manipulation

Respect full-barrier precaution at catheter insertion

Cleanse the skin with a 2 % chlorhexidine/70 % isopropyl alcohol sterile solution

Select subclavian vein as preferred access in the absence of contraindicationsa

Change non-adherent, soiled, or moistened dressing

Remove catheters that are clinically no longer necessary

Basic...

Keywords

Central Venous Catheter Benzalkonium Chloride Intravascular Catheter Chlorhexidine Gluconate Sterile Gauze 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflicts of interest

OM received research grants, lecture, and consultancy fees from CareFusion. VC is supported by a career development award from the Agency for Healthcare Quality Research. JFT received research grants from 3M Company.

References

  1. 1.
    Frasca D, Dahyot-Fizelier C, Mimoz O (2010) Prevention of central venous catheter-related infection in the intensive care unit. Crit Care 14:212CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M, Alfandari S, Plantefeve G, Bronchard R, Troche G, Gauzit R, Antona M, Canet E, Bohe J, Lepape A, Vesin A, Arrault X, Schwebel C, Adrie C, Zahar JR, Ruckly S, Tournegros C, Lucet JC (2012) Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 186:1272–1278CrossRefPubMedGoogle Scholar
  3. 3.
    Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S (2002) Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 136:792–801CrossRefPubMedGoogle Scholar
  4. 4.
    Parienti JJ, du Cheyron D, Ramakers M, Malbruny B, Leclercq R, Le Coutour X, Charbonneau P, Members of the NACRE Study Group (2004) Alcoholic povidone-iodine to prevent central venous catheter colonization: a randomized unit-crossover study. Crit Care Med 32:708–713CrossRefPubMedGoogle Scholar
  5. 5.
    Chopra V, Shojania KG (2013) Recipes for checklists and bundles: one part active ingredient, two parts measurement. BMJ Qual Saf 22:93–96CrossRefPubMedGoogle Scholar
  6. 6.
    Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F, Debaene B (2007) Chlorhexidine-based antiseptic solution versus alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 167:2066–2072CrossRefPubMedGoogle Scholar
  7. 7.
    Girard R, Comby C, Jacques D (2012) Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the prevention of central venous catheter-related infections: in-use comparison. J Infect Public Health 5:35–42CrossRefPubMedGoogle Scholar
  8. 8.
    O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC) (2011) Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:1087–1099CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, UK Department of Health (2014) Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 86(Suppl 1):S1–S70CrossRefPubMedGoogle Scholar
  10. 10.
    Société française d’anesthésie et de réanimation, Société de réanimation de langue française (2009) Prevention of hospital-acquired sepsis in intensive care unit (except cross transmission and neonate). Ann Fr Anesth Reanim 28:912–920CrossRefGoogle Scholar
  11. 11.
    Zamora JL, Price MF, Chuang P, Gentry LO (1985) Inhibition of povidone-iodine’s bactericidal activity by common organic substances: an experimental study. Surgery 98:25–29PubMedGoogle Scholar
  12. 12.
    Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, Mercat A, Bouadma L, Lasocki S, Alfandari S, Friggeri A, Wallet F, Allou N, Ruckly S, Balayn D, Lepape A, Timsit JF, CLEAN trial investigators (2015) Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 386:2069–2077CrossRefPubMedGoogle Scholar
  13. 13.
    Schwebel C, Lucet JC, Vesin A, Arrault X, Calvino-Gunther S, Bouadma L, Timsit JF (2012) Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the dressing study. Crit Care Med 40:11–17CrossRefPubMedGoogle Scholar
  14. 14.
    Casey A, Itrakjy A, Birkett C, Clethro A, Bonser R, Graham T, Mascaro J, Pagano D, Rooney S, Wilson I, Nightingale P, Crosby C, Elliott T (2015) A comparison of the efficacy of 70 % v/v isopropyl alcohol with either 0.5 % w/v or 2 % w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting. Am J Infect Control 43:816–820CrossRefPubMedGoogle Scholar
  15. 15.
    Milstone AM, Passaretti CL, Perl TM (2008) Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 46:274–281CrossRefPubMedGoogle Scholar
  16. 16.
    Dettenkofer M, Wilson C, Gratwohl A, Schmoor C, Bertz H, Frei R, Heim D, Luft D, Schulz S, Widmer AF (2010) Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Clin Microbiol Infect 16:600–606CrossRefPubMedGoogle Scholar
  17. 17.
    Bilir A, Yelken B, Erkan A (2013) Chlorhexidine, octenidine or povidone iodine for catheter-related infections: a randomized controlled trial. J Res Med Sci 18:510–512PubMedPubMedCentralGoogle Scholar
  18. 18.
    Forni C, Sabattini T, D’Alessandro F, Fiorani A, Gamberini S, Maso A, Curci R, Zanotti E, Chiari P (2015) Use of sodium hypochlorite for skin antisepsis before inserting a peripheral venous catheter: a pilot study. Biol Res Nurs 17:330–333CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Olivier Mimoz
    • 1
    • 2
    • 3
  • Vineet Chopra
    • 4
  • Jean-François Timsit
    • 5
    • 6
    • 7
  1. 1.Urgences Adultes-SAMU 86-SMURCHU de PoitiersPoitiersFrance
  2. 2.UFR de Médecine-PharmacieUniversité de PoitiersPoitiersFrance
  3. 3.Institut National de la Santé et de la Recherche Médicale (INSERM) U1070, Pharmacologie des Agents anti-InfectieuxPoitiersFrance
  4. 4.Patient Safety Enhancement Program and Center for Clinical Management ResearchVA Ann Arbor Health System and University of MichiganAnn ArborUSA
  5. 5.Medical Intensive Care Unit, AP-HPBichat University HospitalParisFrance
  6. 6.University Paris Diderot, Sorbonne Paris CitéParisFrance
  7. 7.INSERM, UMR 1137–IAME Team 5–DeSCID: Decision Sciences in Infectious Diseases Control and CareParisFrance

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