The 2002 Hospital Infection Control Practices Advisory Committee Centers for Disease Control and Prevention Guideline for Prevention of Intravascular Device-Related Infection

Reliable vascular access is one of the most essential features of modern medical care. Unfortunately, the intravascular devices (IVDs) needed to establish reliable access are associated with significant potential for producing bloodstream infection (BSI). More than 250 000 IVD-related BSIs occur in the United States each year, each associated with prolongation of hospital stay, a 12% to 25% attributable mortality, and an added cost to health care of $35 000.1 A recent meta-analysis has shown that rates of IVD-related BSI in children and in neonates with different types of IVDs are similar to those encountered in adults.2 Detailed evidence-based recommendations for prevention of IVD-related BSI were first published in 1973,3 then, for the first time by an expert panel convened by the Centers for Disease Control and Prevention’s (CDC’s) Hospital Infection Control Practices Advisory Committee (HICPAC) in 1981,4 and updated in 1996.5 With wide acceptance and consistent implementation of these guidelines, the incidence of central venous catheter (CVC)-associated BSI in US intensive care units (ICUs) has decreased 40% over the past decade.6 HICPAC aided by a panel of authorities has again updated the IVD Guideline,7 with specific recommendations—scored by the quality of the underlying scientific evidence, ranging from consensus theoretical rationale to well-designed, prospective, randomized clinical trials—that cover all aspects of IVD care in both adult and pediatric patients (Table 1). View this table: TABLE 1. Summary of CDC HICPAC Guideline for Prevention of IVD-Related BSIs There are 2 important changes in the new Guideline that apply both to pediatric and adult patients. First, given the evidence for the importance of skin microorganisms in the pathogenesis of IVD-related infection,1 measures to reduce cutaneous colonization of the insertion site would seem of highest priority, particularly the antiseptic used for disinfection of the site before insertion and in … Reprint requests to (J.S.G.) St Joseph Regional Medical Center, 5000 West Chambers St, Milwaukee, WI 53210. E-mail: jsgarland{at}hotmail.com