Are CDC guidelines for prevention of intravascular catheter-related blood stream infections (CRBSI) effective in burn patients?
Introduction: Infection remains the leading cause of morbidity and mortality in the patient. The current Center of Disease Control guidelines recommend against routine catheter changes to prevent catheter related blood stream infections (CRBSI). At our institution the use of the CDC guidelines resulted in rates of CRBSI that were higher than the threshold rates established by the CDC's National Nosocomial Infection Surveillance System (NNIS). The purpose of this study was to determine if routine central venous catheter (CVC) change would result in a decreased rate of CRBSI. Methods : Data was collected over a two year from burn patients admitted to the burn center requiring central venous access. From September 03 to August 04 CDC guidelines were followed, lines were changed only when infection was suspected. From September 04 to August 05 all central venous catheters were changed every five days. Both groups had catheter dressing regimens that consisted of polyurethane dressings placed on top of Aticoat ® . The two groups differed only with respect to dwell time of the central venous catheter. Results :Using CDC guidelines for CVC management resulted in 9.36 CRBSI/1000 catheter days. Routine line change (q5 days) resulted in 3.23 CRBSI/1000 catheter days. There was a significant decrease in the rate of CRBSI with routine CVC change ( p = .017, CI [1.22, 11.06]). Results : CDC guidelines appear to increase the risk of CRBSI in burn patients. Routine catheter change has decreased the rate of CRBSI to levels below the threshold established by the NNIS. Even when CRBSI rates were above threshold levels at our institution, the rate was much lower than previously published reports. This may be as a result of using Acticoat as part of the dressing regimen and warrants further investigation
13th International Society for Burn Injuries Congress, held September 24-29, in Brazil
Published In/Presented At
Lozano, D. D., Howard, P. A., Blome-Eberwein, S. A., Konstantinova, S. Fry, D. (2007). Burns, 33(1), S65-S65. doi:10.1016/j.burns.2006.10.154
Department of Surgery, Department of Surgery Faculty