Vascular catheters inserted in the trenches versus guideline documents: can the discrepancies be resolved?

Infection control personnel familiar with the studies underlying recent guideline recommendations for the prevention of intravascular catheter-related infections could conclude that it would be easy to minimize the risk of such infections. Randomized, controlled trials have demonstrated that prepping the skin with chlorhexidine antiseptic can reduce the risk of catheter-related bloodstream infection (BSI) to less than 1%, using maximal sterile barriers also can reduce the risk of catheter-related BSI to less than 1%, choosing a central venous catheter (CVC) with anti-infective properties can reduce the risk of catheter-related BSI to 1% or less," and, finally, education can reduce the risk of catheter-related BSI associated with physicians-in-training.' Yet, despite these impressive results in short prospective studies, in practice it is uncommon to find endemic catheter-related BSI rates less than 1%.