Microbiological colonization of peripheral venous catheters: a prospective observational study in a Swedish county hospital.

BACKGROUND: Most peripheral venous catheters (PVCs) used in Scandinavia are fitted with an injection port, creating an open PVC system. This port is difficult to disinfect, which may lead to the introduction of micro-organisms upon use. AIM: To investigate the prevalence of microbiological colonization of the injection port and internal lumen of ported PVCs with a minimum dwell time of 48 h at sample collection. METHODS: Adult patients admitted to different medical and surgical departments and the intensive care unit were invited to participate in this prospective observational study. With the PVC in situ, the injection port and internal lumen were swabbed and cultured separately. Demographic and clinical data were collected to compare patients with colonized and non-colonized PVCs. FINDINGS: In total, 300 PVCs from 300 patients were analysed. Of these, 33 patients (11.0%) had at least one positive culture. The colonization locations were as follows: port only, 26 (8.7%); internal lumen only, 5 (1.7%); and port and internal lumen, 2 (0.7%). The colonization rate was significantly higher in the injection port than in the internal lumen (P<0.0001). A ported PVC inserted in the hand incurred a significant risk of colonization (P=0.03). The odds ratio for colonization among patients in the infectious diseases department was 0.1 (95% confidence interval 0.1-1; P<0.06) compared with patients in the medical department. CONCLUSION: This study showed that 11% of ported PVCs were colonized by micro-organisms, with the vast majority (8.7%) of colonization occurring in the injection port. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; ID NCT03351725.

Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.

Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.

Possible transmission of Candida albicans on an intensive care unit: genotype and temporal cluster analyses.

BACKGROUND: Nosocomial transmission of Candida spp. has not been fully explored and previous studies have shown conflicting results. AIM: To evaluate the possible nosocomial transmission of Candida spp. on an intensive care unit (ICU). METHODS: A prospective study was conducted for a period of 19 months, including all patients on our ICU with growth of Candida spp. from surveillance and directed cultures. Molecular typing with repetitive sequence-based polymerase chain reaction was used to define genotype relationships between the Candida albicans and Candida glabrata isolates. Candida isolates obtained from blood cultures taken from patients in our county outside the ICU were used as a reference. Temporal cluster analysis was performed to evaluate genotype distribution over time. FINDINGS: Seventy-seven patients with 78 ICU stays, representing 12% of all ICU stays, were found to harbour 180 isolates of Candida spp. Molecular typing revealed 27 C. albicans genotypes and 10 of C. glabrata. Possible clustering, indicated by overlapping stays of patients with indistinguishable candida genotypes, was observed on seven occasions with C. albicans and on two occasions with C. glabrata. Two C. albicans genotypes were found significantly more often in the ICU group compared with the reference group. Moreover, C. albicans genotypes isolated from more than one patient were significantly more often found in the ICU group. Temporal cluster analysis revealed a significantly increased number of pairs with indistinguishable genotypes at a 21-day interval, indicating clustering. CONCLUSION: This study indicates possible transmission of C. albicans between ICU patients based on genotyping and temporal cluster analysis.

Low incidence of arterial catheter infections in a Swedish intensive care unit: risk factors for colonisation and infection.

There is growing concern that arterial catheters (ACs) cause catheter-related infections (CRIs). Limited data are available concerning risk factors for AC-CRI and there are no studies concerning incidence and micro-organisms from northern Europe. The aims of this study were to determine the incidence of, and micro-organisms responsible for, AC colonisation and AC-CRI in a Swedish intensive care unit (ICU), and to determine risk factors contributing to AC colonisation and AC-CRI. We prospectively studied all patients (N=539) receiving ACs (N=691) in a mixed ICU of a county hospital. Six hundred (87%) of all ACs were assessed completely. The total catheterisation time for 482 patients was 2567 days. The incidence of positive tip culture was 7.8 per 1000 catheter-days, with the predominant micro-organism being coagulase-negative staphylococci (CoNS). The incidence of AC-CRI was 2.0 per 1000 catheter-days (with no cases of bacteraemia). All AC-CRIs were caused by CoNS. Multivariate analysis revealed that immunosuppression, central venous catheter (CVC) colonisation and CVC infection were significant risk factors for AC-CRI. We conclude that AC colonisation and infection with systemic symptoms occur at a low rate in our ICU which supports our practice of basic hygiene routines for the prevention of AC-CRI. Colonisation and infection of a simultaneous CVC seem to be risk factors. The role of contemporaneous colonisation and infection of multiple bloodstream catheters has received little attention previously. Further studies are needed to verify the significance of this finding.

Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors.

BACKGROUND: Catheter-related infection (CRI) is one of the most serious complications of the use of central venous catheters (CVCs), with an incidence of 2-30/1000 days in different studies. No major prospective study has evaluated the rate of CRI in Scandinavia. Since 1999, we have had a thorough programme for the insertion and care of all CVCs used at our hospital and its outpatient clinics. The purpose of this survey was to study the incidence of catheter tip colonization and CRI and their risk factors, and to compare these data with previous non-Scandinavian studies. METHODS: We studied prospectively 605 CVCs in 456 patients in relation to insertion data, patient and catheter characteristics, catheterization time and microbiological cultures. Risk factors were analysed by multivariate analysis. RESULTS: Four hundred and ninety-five (82%) of all CVCs were assessed completely. The total catheterization time was 9010 days. The incidence of positive tip culture was 7.66/1000 days, and the predominant microorganism was coagulase-negative staphylococci. The incidence of CRI was 1.55/1000 days, and the only significant risk factor was the duration of catheterization with a relative risk of 1.009 per day [95% confidence interval (CI), 1.003-1.015]. Of the 14 cases with CRI, six were associated with candida species, and five of these were diagnosed in the intensive care unit. CONCLUSION: In comparison with non-Scandinavian studies, our practice of strict basic hygiene routines for CVC insertion and care is associated with a low incidence of CRI. However, there was a high proportion of candida species amongst these infections. The only risk factor for CRI was the duration of catheterization.

[Infection a dreaded central venous catheter-related complication. A reminder of the significance of good aseptics is justified]. / Infektion en fruktad komplikation till användning av central venkateter. Motiverat att påminna om vikten av god aseptik.

The use of central venous catheters has increased markedly. Large numbers of patients are therefore at risk for catheter-related infections. This paper reviews the literature on prevention of intravascular catheter-related complications. Microbes colonising the catheter hubs and the skin around the insertion site are the source of most of these infections. By simple routines it is possible to reduce the risk for microbial spread from these sites to the bloodstream.

An alternative method to intubate with laryngeal mask and see-through-bougie.

BACKGROUND: Different ways of managing the difficult airway is an important issue for the anaesthetist. We have investigated a technique with a see-through-bougie and laryngeal mask for intubation. METHODS: We report our experience with intubation of 30 patients using a see-through-bougie guided through a laryngeal mask with a fibreoptic bronchoscope. The bougie is then used as a guidance for a tracheal tube. RESULTS: In 29 of the 30 investigated patients, this method could be used. In one patient the method had to be abandoned because of a tortuous trachea. Seventeen patients were intubated within 2 min, 11 between 2 and 5 min and 1 required 10 min. The time was mainly dependent on the endoscopic experience of the anaesthetist. No patient sustained arterial desaturation. CONCLUSION: We conclude that intubation using a see-through-bougie and a laryngeal mask is a valuable method in the difficult intubation situation, when a temporary airway can be achieved with laryngeal mask, since it permits continuous ventilation and visual control throughout the procedure.