Guidelines for preventing infections associated with the insertion and maintenance of central venous catheters

Bloodstream infections associated with the insertion and maintenance of central venous catheters (CVC) are among the most dangerous complications that can occur, worsening the severity of the patients’ underlying ill health, prolonging the period of hospitalisation and increasing the cost of care.1–6 Every year, almost 6,000 patients in the UK acquire a catheter-related bloodstream infection.5,7 Catheter-related bloodstream infection (CR-BSI) involves the presence of systemic infection and evidence implicating the CVC as its source, i.e., the isolation of the same microorganism from blood cultures as that shown to be significantly colonising the CVC of a patient with clinical features of bacteraemia. Colonisation of the catheter, or catheter-related infection (CR-infection), refers to a significant growth of microorganisms on either the endoluminal or the external catheter surface beneath the skin in the absence of systemic infection.7–10 The microorganisms that colonise catheter hubs and the skin adjacent to the insertion site are the source of most CR-BSI. Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, are the most frequently implicated microorganisms associated with CR-BSI. Other microorganisms commonly involved include Staphylococcus aureus, Candida species and enterococci.9 CR-BSI is caused either by cutaneous microorganisms that contaminate the catheter during insertion or migrate along the catheter track, or microorganisms from the hands of health care workers that contaminate and colonise the catheter hub during care interventions.7