Prevention of Intravascular Device-Related Infections

These guidelines have been developed for practitioners who insert catheters and
for persons responsible for surveillance and control of infections in hospital, outpatient,
and home health-care settings. This report was prepared by a working group comprising
members from professional organizations representing the disciplines of critical care
medicine, infectious diseases, health-care infection control, surgery anesthesiology
interventional radiology pulmonary medicine, pediatric medicine, and nursing. The
working group was led by the Centers for Disease Control and Prevention (CDC) and is
intended to replace the Guideline for Prevention of Intravascular Device-Related
Infections published in 1996
These guidelines are intended to provide evidence-based recommendations for
preventing catheter-related infections.
Major areas of emphasis include
1. educating and training health-care providers who insert and maintain catheters;
2. using maximal sterile barrier precautions during central venous catheter
insertion;
3. using a 2% chlorhexidine preparation for skin antisepsis;
4. avoiding routine replacement of central venous catheters as a strategy to prevent
infection; and
5. using antiseptic/antibiotic impregnated short-term central venous catheters if the
rate of infection is high despite adherence to other strategies (i.e., education and
training, maximal sterile barrier precautions, and 2% chlorhexidine for skin
antisepsis). These guidelines also identify performance indicators that can be
used locally by health-care institutions or organizations to monitor their success
in implementing these evidence-based recommendations.

Intravascular catheter-related infections are a major cause of morbidity and mortality in

the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic
gram-negative bacilli, and Candida albicans most commonly cause catheter-related
bloodstream infection. Management of catheter-related infection varies according to the
type of catheter involved. After appropriate cultures of blood and catheter samples are
done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues,
the severity of the patient's acute illness, underlying disease, and the potential
pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and
fungemia, the CVC should be removed. For management of bacteremia and fungemia
from a tunneled catheter or implantable device, such as a port, the decision to remove
the catheter or device should be based on the severity of the patient's illness,
documentation that the vascular-access device is infected, assessment of the specific
pathogen involved, and presence of complications, such as endocarditis, septic
thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is
documented and a specific pathogen is identified, systemic antimicrobial therapy should
be narrowed and consideration given for antibiotic lock therapy, if the CVC or
implantable device is not removed. These guidelines address the issues related to the
management of catheter-related bacteremia and associated complications. Separate
guidelines will address specific issues related to the prevention of catheter-related
infections. Performance indicators for the management of catheter-related infection are
included at the end of the document. Because the pathogenesis of catheter-related
infections is complicated, the virulence of the pathogens is variable, and the host factors
have not been well defined, there is a notable absence of compelling clinical data to
make firm recommendations for an individual patient. Therefore, the recommendations
in these guidelines are intended to support, and not replace, good clinical judgment.
Also, a section on selected, unresolved clinical issues that require further study and
research has been included. There is an urgent need for large, well-designed clinical
studies to delineate management strategies more effectively, which will improve clinical
outcomes and save precious health care resources.