All intravascular devices pose risk of bloodstream infection to patients, study finds
ROCHESTER, Minn. -- All types of intravascular devices (IVDs) pose a risk of bloodstream infection to exposed hospitalized adult patients, finds a study published in the September issue of Mayo Clinic Proceedings. What's more, IVDs have become the leading cause of bloodstream infections in health care settings in the United States and worldwide. An IVD is described as any device that allows access to the bloodstream, but typically a catheter.
As many as 500,000 IVD-related bloodstream infections occur in the United States each year and lead to increased morbidity and prolonged hospital stays, from 10 to 20 days, costing $4,000 to $56,000 per episode. Catheter- or device-related bloodstream infections are widely considered the most preventable class of infections occurring in hospitals.
Authors of the IVD article in Mayo's medical journal extracted data from 200 prospective studies to examine the risk of IVD-related bloodstream infections associated with each type of IVD. Lead author Dennis Maki, M.D., a researcher and infectious disease and critical care specialist at the University of Wisconsin Hospital and Clinics in Madison, says the findings offer "hard data" that IVDs pose a risk to all recipients.
"We thought this analysis might provide a unique opportunity to wave the flag and convince both health care workers and patients that all types of IVDs pose a risk," Dr. Maki says. "Clinicians and quality assurance experts need to understand that these risks are significant and are often greater than they might think."
The use of specialized IVDs for long-term or indefinite vascular access has dramatically increased in recent years in hospital and especially outpatient settings, but attention to reducing incidence of bloodstream infections has focused almost exclusively on patients with short-term central venous catheters in intensive care units, Dr. Maki says. In the last decade, virtually all progress in control of IVD-related bloodstream infections has been restricted to this relatively small fraction of hospitalized patients.
The same strategies need to be implemented on a far wider scale, argue the researchers, to make IVDs safer for all hospitalized patients, as well as outpatients who have IVDs.
Guidelines -- such as those published by the Centers for Disease Control's (CDC) Hospital Infection Control Practices Advisory Committee in 2002 -- exist for prevention of IVD-related bloodstream infections and need to be adapted more widely by health care providers to ensure safer IVD use. Reduced bloodstream infections will follow, predicts Dr. Maki.
The article's authors also urge wider use of novel IVD technologies designed to reduce IVD-related bloodstream infections. In an accompanying editorial, David Snydman, M.D., of Tufts-New England Medical Center, also cites advancing technology as a promising means for reducing IVD-related bloodstream infections.
"Technology holds far more promise for reducing risk than behavioral modification," Dr. Maki says. "We believe that it holds the greatest promise. In our paper, we point up a number of IVD technologies that have been proven to be effective, but, as yet, inexplicably, aren't widely used."
Although consumers may be surprised to learn that all IVDs carry a risk of bloodstream infection, Dr. Maki advises them to become better informed, not alarmed. Vascular access is absolutely essential to today's health care and in many cases is lifesaving, he says. But if an IVD insertion is scheduled, patients should feel comfortable asking their health care providers what measures will be taken to minimize their risk of bloodstream infection, Dr. Maki says.
Co-authors of the IVD article are Daniel Kluger, M.D., and Christopher Crnich, M.D., of the University of Wisconsin Medical School and the Infectious Disease Section of the Department of Medicine, University of Wisconsin Hospital and Clinics in Madison.
A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.
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