A 66-year-old woman is hospitalized for the worst headache of her life. CT scan of the head without contrast shows diffuse subarachnoid hemorrhage with intraventricular extension and hydrocephalus. Because of the patient's deteriorating mental status and agitation, her trachea is cannulated and a central venous catheter is placed.
Which of the following is the most effective strategy to decrease this patient's risk for developing catheter-related infection?

Question

A 66-year-old woman is hospitalized for the worst headache of her life.  CT scan of the head without contrast shows diffuse subarachnoid hemorrhage with intraventricular extension and hydrocephalus.  Because of the patient's deteriorating mental status and agitation, her trachea is cannulated and a central venous catheter is placed.
Which of the following is the most effective strategy to decrease this patient's risk for developing catheter-related infection?

Quizplus · Accepted Answer

11ec193a_9700_ead2_853d_9b5c8ce2d8f3_MD0002_00 Measures to prevent catheter-related infection include proper hand hygiene, sterile catheter insertion using chlorhexidine skin disinfection, and maximal sterile barrier precautions. Catheters inserted without these techniques should be removed within 24-48 hours. Infection rate also depends on the site of insertion, with lower risk in subclavian compared to internal jugular and femoral catheters (Choice B). Fewer ports and antimicrobial-impregnated catheters also reduce infection (Choice E). Peripheral catheters inserted with sterile technique should be removed after 72-96 hours to reduce risk of infection. However, there is no definitive replacement time for central catheters, and routine replacement is not recommended as it increases mechanical complications without decreasing infection risk (Choice D). Replacement is indicated in suspected catheter infection (eg, purulence, fever, and hemodynamic instability). Guidewire technique for replacement increases infection risk and is not recommended. Daily chlorhexidine baths in the intensive care unit also reduce central catheter-related infection. Prophylactic topical and systemic antibiotics are not recommended as they promote fungal infections and antibiotic resistance (Choice C). Catheters should be monitored regularly and removed if tenderness or erythema is present or if they are no longer needed. Educational objective: Prevention of catheter-related infections includes maximal sterile barrier precautions with insertion, chlorhexidine skin disinfection, and the use of antibiotic-impregnated catheters. Femoral insertion site, routine replacement of central catheters, and prophylactic antibiotics are not recommended. __________ References: Summary of recommendations: Guidelines for the prevention of intravascular catheter-related infections. (http://www.ncbi.nlm.nih.gov/pubmed/21467014) Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability. (http://www.ncbi.nlm.nih.gov/pubmed/22482848) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. (http://www.ncbi.nlm.nih.gov/pubmed/12233868)

A 66-Year-Old Woman Is Hospitalized for the Worst Headache of Her