Vascular access risks must be reduced

The latest breakthroughs were examined and some promising interventions highlighted. LOUISE FRAMPTON reports.

Despite many initiatives to reduce bloodstream infections, including the introduction of antimicrobial Central Venous Catheters (CVCs), vascular access devices remain the number one cause of bacteraemia. The issue of catheter-related bloodstream infections and the risks associated with access devices were recently dealt with during a symposium, sponsored by Baxter Healthcare, at a healthcare-acquired infections conference organised by The Lancet. Highlighting the scale of the problem, Professor Tom Elliott, consultant microbiologist and deputy medical director, University Hospital Birmingham, pointed out that around 6,000 cases of infection are associated with the use of short-term CVCs in England each year. Although the cost has been estimated to be around £10 million, he believes this is likely to be the “tip of the iceberg”. “More accurate data would probably show that the cost is many more millions of pounds,” he said. “Depending on the infection which caused sepsis, mortality can be up to 25%.” He pointed out that the most common cause of catheter-related bloodstream infections is staphylococci – coagulasenegative staphylococci accounts for around 40% of sepsis cases, while Staphylococcus aureus accounts for approximately 25%. Other microorganisms responsible include: gram negatives, Pseudomonas, Serratia and – to a lesser extent – Candida. Routes for access can be through hub/connector colonisation or via the patient’s skin, by “tracking down” the catheter surface, he explained. Another route, generally overlooked, is at the time of insertion – as a clinician pushes the catheter through the skin, organisms may be impacted on to the distal tip. Prof. Elliott highlighted a study which found that 18% of catheters were contaminated at the start of the procedure, raising the question: “Is the battle lost at the time of insertion?”

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