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KEY POINTS

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KEY POINTS

  1. Health care–associated infections (HCAIs) contribute significantly to morbidity and mortality, and health care costs.

  2. The most frequent HAIs are catheter-related bloodstream infections (CRBSIs), ventilator-associated pneumonias (VAPs), infections with Clostridium difficile, surgical site infections (SSIs), and catheter-associated urinary tract infections (CAUTIs).

  3. Major preventive strategies to reduce CRBSIs include optimal catheter site selection; proper hand hygiene; maximal barrier precautions at the time of insertion; chlorhexidine skin antisepsis, use of chlorhexidine-impregnated dressings, or use of antiseptic or antimicrobial-coated catheters; tunneled insertion; catheter site care and limited manipulation of the catheter; and daily review of line necessity and prompt removal of unnecessary lines.

  4. The most common causes for VAPs are aerobic gram-negative bacilli such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter species and less commonly gram-positive organisms such as Staphylococcus aureus.

  5. C difficile can cause a wide range of disease from asymptomatic infection in a silent carrier state to fulminant disease associated with severe sepsis and death.

  6. Essential elements of the SSI bundle include appropriate use of prophylactic antibiotics; appropriate hair removal, controlled postoperative serum glucose in patients after cardiac surgery, and immediate postoperative normothermia in patients with colorectal surgery.

  7. The single most significant risk factor for a CAUTI is the prolonged use of the urinary catheter.

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INTRODUCTION

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HCAIs, particularly those acquired in a critical care setting contribute significantly to morbidity and mortality, and health care costs. Critically ill patients have more comorbid diagnoses and higher severity of acute illness making them particularly susceptible to new infections while hospitalized. Indwelling catheters and increasing prevalence of multidrug-resistant (MDR) pathogens add to the risk and negative consequences of HCAIs. One in 20 patients acquires a HCAI while receiving medical care.1 The most frequent HCAIs include bloodstream infections (BSIs), VAPs, infections with C difficile, SSIs, and CAUTIs.

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Bloodstream Infections

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BSIs or bacteremias remain common in hospitalized patients both within the intensive care units (ICUs) and in hospital wards. About 90% of these BSIs are associated with a catheter in the bloodstream, usually a central line.2 CRBSIs are considered a preventable cause of morbidity and mortality and are a target of interventions aimed at improving quality of health care and cost-effectiveness.

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Risk Factors and microbiology
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Central lines are at risk for infection both during the process of insertion and subsequent access and maintenance. Factors associated with a lower incidence of CRBSIs include the following:

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  • Optimal catheter site selection (subclavian vs internal jugular, or femoral veins)

  • Use of proper hand hygiene

  • Maximal barrier precautions at the time of insertion

  • Chlorhexidine skin antisepsis, use of chlorhexidine-impregnated dressings, or use of catheters coated with antiseptic or antimicrobials

  • Tunneled insertion

  • Catheter site care and limited manipulation of the catheter

  • Daily review of line necessity and prompt removal of unnecessary lines

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Gram-positive aerobes are the most frequently isolated pathogens ...

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