How to reduce the chance of a symptomatic infection in catheter management?

Reducing Catheter-Associated Infections: Evidence-Based Prevention Strategies

To reduce symptomatic catheter-related infections, implement a comprehensive bundle including daily 2% chlorhexidine skin cleansing, chlorhexidine-impregnated dressings for short-term catheters, maximal sterile barrier precautions during insertion, and most importantly—remove the catheter as soon as it is no longer clinically necessary. 1

Core Prevention Strategies for All Catheters

Skin Antisepsis and Patient Hygiene

• Use 2% chlorhexidine wash for daily skin cleansing to reduce catheter-related bloodstream infections (CRBSI), as this is more effective than povidone-iodine preparations 1
• Apply chlorhexidine preparation with alcohol (>0.5%) for skin antisepsis during central venous catheter (CVC) insertion 1

Dressing Management

• Replace gauze dressings on short-term CVC sites every 2 days 1
• Replace transparent dressings at least every 7 days for short-term CVCs (unless soiled or loose) 1
• Use chlorhexidine-impregnated sponge dressings for temporary short-term catheters in patients older than 2 months if infection rates remain elevated despite basic prevention measures 1
• Monitor catheter sites visually during dressing changes or by palpation through intact dressings; remove dressings immediately if patients develop tenderness, fever without obvious source, or signs suggesting infection 1

Catheter Securement

• Use sutureless securement devices rather than sutures to reduce infection risk for intravascular catheters 1

Antimicrobial-Impregnated Catheters

Consider chlorhexidine/silver sulfadiazine or minocycline/rifampin-impregnated CVCs for patients whose catheter is expected to remain in place >5 days if CLABSI rates remain elevated despite implementing education, maximal sterile barrier precautions, and chlorhexidine skin antisepsis 1

Critical "Do Not Do" Recommendations

Avoid Routine Prophylactic Antibiotics

• Do NOT administer systemic antimicrobial prophylaxis routinely before insertion or during catheter use to prevent colonization or CRBSI 1
• This approach is ineffective and promotes antimicrobial resistance 1

Avoid Routine Catheter Replacement

• Do NOT routinely replace CVCs, PICCs, hemodialysis catheters, or pulmonary artery catheters at fixed intervals to prevent infection 1, 2, 3
• Do NOT remove catheters based on fever alone—use clinical judgment to assess for other infection sources 1, 2, 3
• For peripheral catheters in adults, replacement every 72-96 hours is appropriate to prevent phlebitis, but not more frequently 1

Avoid Anticoagulants for Infection Prevention

• Do NOT routinely use anticoagulant therapy to reduce catheter-related infection risk in general patient populations 1

Special Considerations for Hemodialysis Catheters

Topical Antiseptic Ointments

• Use povidone-iodine or bacitracin/gramicidin/polymyxin B ointment at hemodialysis catheter exit sites after insertion and at the end of each dialysis session, but only if compatible with catheter material per manufacturer recommendations 1

Antibiotic Lock Prophylaxis

• Use prophylactic antimicrobial lock solution in patients with long-term catheters who have a history of multiple CRBSI despite optimal adherence to aseptic technique 1, 4
• Antibiotic lock therapy should be combined with systemic antibiotics for 10-14 days when treating active CRBSI, not used alone 4
• Success rates vary by pathogen: 87-100% for gram-negative organisms, 75-84% for coagulase-negative staphylococci, but only 40-55% for S. aureus 4

Urinary Catheter-Specific Prevention

Primary Prevention Strategy

• The most effective prevention is restricting indwelling urinary catheter use to limited indications and discontinuing as soon as feasible 5, 6
• Consider alternate bladder management: external condom catheters for men or intermittent catheterization for patients with neurologic impairment 5

Replacement Strategy

• Do NOT replace long-term urinary catheters at routine fixed intervals—replace only for clinical indications such as blockage, leakage, encrustation, or infection 2, 3
• If a catheter has been in place ≥2 weeks at onset of catheter-associated UTI and continued catheterization is necessary, replace the catheter to hasten symptom resolution and reduce subsequent infection risk 2, 3

Most Important Pitfall to Avoid

The single most critical error is leaving catheters in place longer than medically necessary. Daily evaluation of continued need for catheterization and prompt removal when no longer indicated is the most effective infection prevention strategy across all catheter types 2, 3, 5, 6. This simple measure reduces infection risk more than any technological intervention.