Legal Eagle Eye Newsletter for the Nursing Profession(4)2 Nov 95  update

   Quick Summary: New CDC guidelines for IV infection control practices pertain to peripheral venous and arterial catheters, central venous and arterial catheters, peripherally inserted central venous catheters, pressure monitoring systems and newer devices such as antimicrobial-impregnated catheters and needleless infusion systems.   FEDERAL REGISTER, September 27, 1995, Pages 49978 - 50006.

 

   The Centers for Disease Control and Prevention (CDC) has published new guidelines for infection control practices related to intravascular devices. The new guidelines are presently only in the draft stage, meaning that the new guidelines have been published by the CDC for public comment from interested healthcare professionals, but are not yet a mandatory part of Federal law. The new guidelines are intended to replace those promulgated in 1983.

   The CDC has indicated that interested parties may order a copy of the Federal Register in which the new guidelines appear (Vol. 60, No. 187., Wednesday, September 27, 1995, pp. 49978 - 50006) by contacting the U.S. Government Printing Office, Order and Information Desk, Washington, DC 20402-9329, phone (202) 512-1800. The Federal Register is also available for inspection and copying at many academic libraries, courthouse law libraries and public libraries around the U.S., as well as official U.S. Government Depository Libraries.

   The CDC has also suggested that interested persons contact the IV Guideline Information Center at (404) 332-2569 for further information.

   Extensive discussion of the bacterial epidemiology of IV-related infections accompanies the CDC’s draft guidelines. Staph epidermidis is now the most frequently isolated pathogen in catheter-related infections, having replaced Staph aureus, which was the primary cause of such infections identified in 1986. There is an alarming rise in the incidence of IV infections related to vancomycin-resistant enteric bacteria, particularly in oncology and transplant patients and those with indwelling IV devices, according to the CDC. Fungal pathogens also represent an increasing proportion of nosocomial infections.

   According to the CDC, "Strict adherence to handwashing and aseptic technique remains the cornerstone of prevention of IV-catheter-related infections."

   The CDC also recommends selection of an appropriate site of catheter insertion, selection of appropriate catheter materials, use of barrier precautions during catheter insertion, change of catheters and administration materials at appropriate intervals, catheter site care and the use of filters, flush solutions, prophylactic antimicrobials and conversion to newer IV devices such as impregnated catheters and needleless infusion systems.

   In general, the CDC says to leave IV site dressings in place until the catheter is removed or changed, or until the dressing becomes damp, loosened or soiled. Change IV tubing, including piggyback tubing, no more frequently than at 72 hour intervals. No recommendation for frequency of change beyond 72 hour interval. Change tubing used for blood or blood products within 24 hours of completing infusion. Do not leave TPN fluids hanging more than 24 hours. No CDC recommendation for "hang time" of other IV fluids.

   Peripheral venous catheters: For adults, change catheter and rotate site every 48 - 72 hours. Replace catheters inserted under emergency conditions within 24 hours. No recommendation for routine use of antimicrobial ointment at IV site.

   Peripheral arterial catheters and pressure monitoring devices: For adults, change catheter and rotate insertion sites every 4 days. Replace disposable or reusable transducers at 96-hour intervals. Replace other components of the system, including tubing, flush device and flush solution when transducer is changed.

   Central hemodialysis catheters: No recommendation for frequency of catheter change. Do not use for purposes other than hemodialysis, e.g. not for IV fluids, blood products or TPN. Apply providone-iodine ointment to the catheter insertion site before and after hemodialysis.

   Central venous catheters: Do not routinely change percutaneously-inserted central venous catheters. No recommendation for change of tunneled catheters and ports. Do not routinely apply antimicrobial ointment to catheter insertion site.

   For pediatric patients, the CDC is not making recommendations at this time for frequency of catheter changes, tubing changes, "hang time" of fluids, etc.

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