Catheter-Related Bloodstream Infection in the Intensive Care Unit

Catheter-related bloodstream infection (CRBSI) is a significant cause of morbidity and mortality in the intensive care unit, contributing to prolonged stay with the associated cost and resource implications. Various mechanisms of infection have been suggested, and consequently, numerous interventions to reduce the burden of infection have been proposed, the efficacy of most of which remains controversial. The practice of routine catheter change and preferential use of the subclavian vein insertion site are both associated with an increased risk of mechanical complications, which may outweigh any potential benefit. Additionally, the use of silver- and antiseptic-impregnated catheters, of questionable benefit in the ICU patient population, is also argued to be unjustified in terms of efficacy and cost. A small scale study in a London university district general hospital ICU found that while infection rates were low, the majority of infections were caused by Staphylococcus epidermidis and thus were probably a result of contamination either from the patient's commensal flora or acquired by contamination from healthcare workers. In accordance with published findings, this suggests that preventing contamination will decrease infection rates. Strict aseptic technique and the use of sterile fields during insertion are most likely the main contributors in reducing rates of infection. This together with education of staff across disciplines and adherence to local guidelines are likely to be the mainstays of reducing CRBSI in the ICU.