Catheter sharply reduces catheter-related infections
Extra cost could save money in the long haul
A recent study conducted by researchers at the University of Wisconsin Hospitals and Clinics shows that the use of catheters coated with silver sulfadiazine and chlorhexidine reduces the overall risk for nosocomial bloodstream infections by 45%.1 (See chart, p. 5.)
"The results were impressive," notes Kay Coulter, CRNI, of Coulter Consulting in Clearwater, FL. In addition to the results, which show dramatically reduced bloodstream infections, Coulter says she found two of the study’s other findings noteworthy.
"First, in the study, they documented that these antiseptic catheters have the potential to be left in longer 10 to 15 days," she says. "In hospitals they are routinely rotated every three to seven days. The dollar savings alone in the reduction of the routine rotation would be significant. And because we have more patients going home with these short-term traditional central catheters, home care could feel more comfortable about a non-tunneled subclavian line."
The second point Coulter found noteworthy and a point which unfortunately holds true, is that the study also points to a lack of quality of control among care providers and caregivers who provide central line care.
"Where the study says Innovations that implicitly prevent microorganisms from colonizing the implanted catheter can help reduce the effect of poor aseptic technique,’ that’s a veiled way of saying there are people out there who don’t utilize proper aseptic technique and may be putting patients at risk because of poor care of central lines, and it’s very true," says Coulter.
She notes that many home health providers caring for infusion patients may not see the need for IV-trained nurses. "They believe that a nurse is a nurse is a nurse, and anyone can deliver IV therapy," she says. "Companies do not always provide infusion orientation or education for a nurse they send out to do a central line dressing change."
Coulter points out that an antiseptic catheter is a big step in helping to reduce infections but isn’t likely to entirely overcome poor technique.
"We must practice aseptic technique and combine multiple approaches, such as hand washing, considering the type of disinfecting agent, and length of time we leave the agent on the skin and sterile dressing on the site," she says. "If you miss any of those steps in the process of caring for a central line, you put the patient at risk. What they’re doing with this antiseptic catheter is making another tool available that will assist in reducing the occurrence of infection."
The study’s lead researcher, Dennis Maki, MD, an Ovido Meyer Professor of Medicine at the University of Wisconsin Medical School and the head of the infectious disease section at the University of Wisconsin Hospital and Clinics agrees that the antiseptic catheter (ARROWguard Blue) used in the study is a step in the right direction.
"It’s the first commercially available catheter that we feel confident can reduce the risk of catheter-related bloodstream infection," he says. "Moreover, it does not appear to promote antibiotic resistance."
The study compared two noncuffed, triple-lumen central venous catheters manufactured by Arrow International in Reading, PA. One catheter was a standard 30.5-cm, 16-G catheter made of polyurethane. The test catheter, the ARROWguard Blue catheter, is identical to the control catheter except its external surface is impregnated with small quantities of chlorhexidine gluconate (0.75 mg) and silver sulfadiazine (0.70 mg).
A total of 158 adults and 403 catheters were evaluated in the study, which was conducted at the Center for Trauma and Life Support, a medical-surgical intensive care unit in the University of Wisconsin Hospital and Clinics.
The results found that the antiseptic catheters were less likely to be colonized at removal than the control catheters, with 13.5 compared with 24.1 colonized catheters per 100. The antiseptic catheters were also found to be much less likely to produce bloodstream infection, with one compared with 4.7 infections per 100 catheters, and 1.6 compared with 4.7 infections per 1,000 catheter days.
The study was made possible in part through a grant from Arrow, which says such a study was necessary for the catheter to gain widespread acceptance.
"We’ve been selling that product for about four or five years," says Paul Frankhouser, Arrow’s vice president of marketing. "We needed to get the peer reviewed journal article published because everyone wants to see the evidence, and it took Dr. Maki several years to complete the study and get it published."
Frankhouser notes that the catheter costs about $20 more than similar non-antiseptic catheters. But such costs could be justified in the long run, says Maki.
"We know that a catheter-related bloodstream infection increases the length of stay anywhere from five to ten days, and it increases the cost of health care over $30,000," he says. "If we can prevent enough catheter-related bloodstream infections, we’ll save money in the long run though this catheter."
Maki also notes the importance of reducing infections because of the continued increase of antibiotic-resistant organisms. (See Home Infusion Therapy Management, December 1997, pp. 152-154.)
"We are now running into organisms that cannot be treated with standard antibiotics; there are not standard antibiotics that work, such as vancomycin-resistant enterococcus," he says. "It’s clear we have to work even harder to prevent infections. This antiseptic catheter is a huge advance in the direction of novel technology to prevent infections of all types including infections caused by antibiotic-resistant organisms."
Reference
1. Maki D, Stolz S, Wheeler S, et al. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. Ann Intern Med 1997; 127:257-266.
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