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Failure to Follow Guidelines Threatens Increase in Arterial Catheter Infections

October 12th, 2016

PROVIDENCE, RI – Despite the risk of increased infections, a large percentage of hospital personnel fail to follow guidelines on placement of arterial catheters in intensive care unit patients, according to a recent report.

The research, published recently in Critical Care Medicine, was based on a survey conducted by Rhode Island Hospital researchers. It found significant variability in how those catheters are managed, despite infection prevention guidelines provided by the Centers for Disease Control and Prevention.

"Barrier precautions are employed inconsistently by critical care clinicians across the nation, and such individuals underestimate the infection risks posed by arterial catheters," said co-author Leonard A. Mermel, DO, ScM, "Every effort should be made to prevent such infections since they lead to increased cost, length of stay, and morbidity."

CDC recommendations published in 2011 specify that clinicians wear sterile gloves, a surgical cap and surgical mask, and use a small sterile drape when inserting arterial catheters. Yet, of 1,265 study respondents, only 44% reported using the CDC-recommended barrier precautions during insertion and only15% reported using full barrier protections.

"There appears to be a significant deviation from clinical guidelines regarding a very commonly performed procedure in critically ill patients," corresponding author Andrew Levinson, MD, MPH, added in a Lifespan Hospitals press release. "Bloodstream infections are largely preventable, and if the survey results mirror the clinical practice in the U.S., there's work to be done in reducing risk of such infections."

Respondents to the anonymous survey included 1,029 members of the Society of Critical Care Medicine, specifically attending physicians, fellows, residents, nurse practitioners, physician assistants, registered nurses and respiratory therapists. The survey was sent to 11,361 and had an 11% response rate before exclusions were applied.

Recent studies have indicated that the occurrence rate of bloodstream infections associated with arterial catheters, used to monitor blood pressure and directly sample blood gasses, is 0.9-3.4 per 1,000 catheter-day, which is comparable to central venous catheters.

“Clinicians significantly underestimated the infectious risk posed by arterial catheters, and support for mandatory use of full barrier precautions was low,” study authors conclude. “Further studies are warranted to determine the optimal preventive strategies for reducing bloodstream infections associated with arterial catheters."