A 37-year-old man is brought to the emergency department following a motor vehicle accident in which he was the unrestrained driver. Paramedics report that his breath smelled of alcohol at the scene. En route to the hospital, the patient receives 2 L intravenous normal saline. In the emergency department, his blood pressure is 100/60 mm Hg, pulse is 130/min, and respirations are 44/min. He is admitted directly to the intensive care unit, where he is intubated and placed on mechanical ventilation. A decision is made to insert a central venous catheter. In addition to sterile draping during the procedure, which of the following actions would be most likely to prevent intravascular catheter-related infections?

Question

A 37-year-old man is brought to the emergency department following a motor vehicle accident in which he was the unrestrained driver.  Paramedics report that his breath smelled of alcohol at the scene.  En route to the hospital, the patient receives 2 L intravenous normal saline.  In the emergency department, his blood pressure is 100/60 mm Hg, pulse is 130/min, and respirations are 44/min.  He is admitted directly to the intensive care unit, where he is intubated and placed on mechanical ventilation.  A decision is made to insert a central venous catheter.  In addition to sterile draping during the procedure, which of the following actions would be most likely to prevent intravascular catheter-related infections?

Quizplus · Accepted Answer

Central venous catheters (CVCs) are commonly used for hemodynamic monitoring and administration of fluids and medications in critically ill patients. Infection originating from the patient's skin flora or bacteria on the hands of health care workers is one of the major complications of CVCs. Gram-positive cocci, primarily coagulase-negative staphylococci and Staphylococcus aureus, account for the majority of these infections. The Centers for Disease Control and Prevention recommend the following steps to reduce CVC infections: (Choice B) Topical antimicrobial ointments do not reduce the rate of CVC-related infections and are associated with increased risk of antimicrobial resistance and Candida colonization. (Choice D) Oral or parenteral antibiotics have not been found to reduce the incidence of CVC-related infections. In addition, the prophylactic use of vancomycin has been found to increase the risk of vancomycin-resistant enterococcus. (Choice E) Catheter replacement at scheduled intervals does not reduce infection rates. Routine replacement of CVCs is not necessary for functional catheters with no evidence of infection. Educational objective: The most important steps for prevention of central venous catheter infections are as follows: __________ References: Beyond the bundle--journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections. (http://www.ncbi.nlm.nih.gov/pubmed/23497591)

A 37-Year-Old Man Is Brought to the Emergency Department Following