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Dennis G. Maki - One of the best experts on this subject based on the ideXlab platform.

  • Intravascular Catheter and Implantable Device Infections in Transplant Patients
    Principles and Practice of Transplant Infectious Diseases, 2019
    Co-Authors: Nasia Safdar, Cybele Lara R. Abad, Dennis G. Maki
    Abstract:

    The use of Intravascular Devices for administration of drugs, fluids, blood products, and nutritional support is essential in patients undergoing transplantation procedures. These Intravascular Devices have a significant potential to produce iatrogenic disease, such as bloodstream infection originating from colonization of the indwelling Intravascular Devices. Over two-thirds of all healthcare-associated bacteremia originate from Devices used for vascular access. Patients undergoing hematopoietic stem cell transplantation, who have inherently compromised immune function because of their cancer and are further incapacitated due to the preparatory pretransplant conditioning regimen or graft-versus-host disease, are particularly prone to Device-related infections. In this chapter, a comprehensive review of epidemiology, disease pathogenesis, clinical presentation, treatment, and prevention of Intravascular Device-related infections is presented.

  • the risk of bloodstream infection in adults with different Intravascular Devices a systematic review of 200 published prospective studies
    Mayo Clinic Proceedings, 2006
    Co-Authors: Dennis G. Maki, Daniel M Kluger, Christopher J Crnich
    Abstract:

    OBJECTIVE: To better understand the absolute and relative risks of bloodstream infection (BSI) associated with the various types of Intravascular Devices (IVDs), we analyzed 200 published studies of adults in which every Device in the study population was prospectively evaluated for evidence of associated infection and microbiologically based criteria were used to define IVD-related BSI. METHODS: English-language reports of prospective studies of adults published between January 1, 1966, and July 1, 2005, were identified by MEDLINE search using the following general search strategy: bacteremia [Medical Subject Heading, MeSH] OR septicemia [MeSH] OR bloodstream infection AND the specific type of Intravascular Device (eg, central venous port). Mean rates of IVDrelated BSI were calculated from pooled data for each type of Device and expressed as BSIs per 100 IVDs (%) and per 1000 IVD days. RESULTS: Point incidence rates of IVD-related BSI were lowest with peripheral intravenous catheters (0.1%, 0.5 per 1000 IVDdays) and midline catheters (0.4%, 0.2 per 1000 catheter-days). Far higher rates were seen with short-term noncuffed and nonmedicated central venous catheters (CVCs) (4.4%, 2.7 per 1000 catheter-days). Arterial catheters used for hemodynamic monitoring (0.8%, 1.7 per 1000 catheter-days) and peripherally inserted central catheters used in hospitalized patients (2.4%, 2.1 per 1000 catheter-days) posed risks approaching those seen with short-term conventional CVCs used in the intensive care unit. Surgically implanted long-term central venous Devices—cuffed and tunneled catheters (22.5%, 1.6 per 1000 IVD-days) and central venous ports (3.6%, 0.1 per 1000 IVD-days)—appear to have high rates of infection when risk is expressed as BSIs per 100 IVDs but actually pose much lower risk when rates are expressed per 1000 IVD-days. The use of cuffed and tunneled dual lumen CVCs rather than noncuffed, nontunneled catheters for temporary hemodialysis and novel preventive technologies, such as CVCs with anti-infective surfaces, was associated with considerably lower rates of catheter-related BSI. CONCLUSIONS: Expressing risk of IVD-related BSI per 1000 IVDdays rather than BSIs per 100 IVDs allows for more meaningful estimates of risk. These data, based on prospective studies in which every IVD in the study cohort was analyzed for evidence of infection by microbiologically based criteria, show that all types of IVDs pose a risk of IVD-related BSI and can be used for benchmarking rates of infection caused by the various types of IVDs in use at the present time. Since almost all the national effort and progress to date to reduce the risk of IVD-related infection have focused on short-term noncuffed CVCs used in intensive care units, infection control programs must now strive to consistently apply essential control measures and preventive technologies with all types of IVDs.

  • the effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for Intravascular access
    Infection Control and Hospital Epidemiology, 2005
    Co-Authors: Christopher J Crnich, Jeremy A Halfmann, Wendy C Crone, Dennis G. Maki
    Abstract:

    BACKGROUND: Products containing alcohol are commonly used with Intravascular Devices at insertion, to remove lipids from occluded Intravascular Devices used during parenteral nutrition, and increasingly for the prevention and treatment of Intravascular Device-related bloodstream infection. The effects of alcohol on the integrity of Intravascular Devices remain unknown. METHODS: Two types of widely used commercial peripherally inserted central catheters, one made of polyetherurethane and one made of silicone, were exposed to a 70% ethanol lock solution for up to 10 weeks. Mechanical testing was performed to identify force-at-break, stress, strain, modulus of elasticity, modulus of toughness, and wall area of ethanol-exposed and control catheters. RESULTS: No significant differences between exposed and unexposed catheters were identified for any of the mechanical parameters tested except for a marginal reduction in the modulus of elasticity for both polyetherurethane and silicone catheters and minor increases in the wall area of polyetherurethane catheters. CONCLUSIONS: These data indicate that exposure to a 70% ethanol lock solution does not appreciably alter the integrity of selected commercial polyetherurethane and silicone catheters. Given the greatly expanded use of alcoholic solutions with Intravascular Devices of all types, we believe that manufacturers would be well advised to subject their catheters and other Intravascular Devices to formal testing of the type employed in this study.

  • guidelines for the prevention of Intravascular catheter related infections the hospital infection control practices advisory committee center for disese control and prevention u s
    Pediatrics, 2002
    Co-Authors: Naomi P Ogrady, Dennis G. Maki, Mary Alexander, Patchen E Dellinger, Julie L Gerberding, Stephen O Heard, Henry Masur, Rita D Mccormick, Leonard A Mermel, Michele L Pearson
    Abstract:

    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 Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of 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 (ie, 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.

  • guidelines for the prevention of Intravascular catheter related infections centers for disease control and prevention
    MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports Centers for Disease Control, 2002
    Co-Authors: Naomi P Ogrady, Dennis G. Maki, Mary Alexander, Patchen E Dellinger, Julie L Gerberding, Stephen O Heard, Henry Masur, Rita D Mccormick, Leonard A Mermel, Michele L Pearson
    Abstract:

    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 Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of 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.

Christopher J Crnich - One of the best experts on this subject based on the ideXlab platform.

  • the risk of bloodstream infection in adults with different Intravascular Devices a systematic review of 200 published prospective studies
    Mayo Clinic Proceedings, 2006
    Co-Authors: Dennis G. Maki, Daniel M Kluger, Christopher J Crnich
    Abstract:

    OBJECTIVE: To better understand the absolute and relative risks of bloodstream infection (BSI) associated with the various types of Intravascular Devices (IVDs), we analyzed 200 published studies of adults in which every Device in the study population was prospectively evaluated for evidence of associated infection and microbiologically based criteria were used to define IVD-related BSI. METHODS: English-language reports of prospective studies of adults published between January 1, 1966, and July 1, 2005, were identified by MEDLINE search using the following general search strategy: bacteremia [Medical Subject Heading, MeSH] OR septicemia [MeSH] OR bloodstream infection AND the specific type of Intravascular Device (eg, central venous port). Mean rates of IVDrelated BSI were calculated from pooled data for each type of Device and expressed as BSIs per 100 IVDs (%) and per 1000 IVD days. RESULTS: Point incidence rates of IVD-related BSI were lowest with peripheral intravenous catheters (0.1%, 0.5 per 1000 IVDdays) and midline catheters (0.4%, 0.2 per 1000 catheter-days). Far higher rates were seen with short-term noncuffed and nonmedicated central venous catheters (CVCs) (4.4%, 2.7 per 1000 catheter-days). Arterial catheters used for hemodynamic monitoring (0.8%, 1.7 per 1000 catheter-days) and peripherally inserted central catheters used in hospitalized patients (2.4%, 2.1 per 1000 catheter-days) posed risks approaching those seen with short-term conventional CVCs used in the intensive care unit. Surgically implanted long-term central venous Devices—cuffed and tunneled catheters (22.5%, 1.6 per 1000 IVD-days) and central venous ports (3.6%, 0.1 per 1000 IVD-days)—appear to have high rates of infection when risk is expressed as BSIs per 100 IVDs but actually pose much lower risk when rates are expressed per 1000 IVD-days. The use of cuffed and tunneled dual lumen CVCs rather than noncuffed, nontunneled catheters for temporary hemodialysis and novel preventive technologies, such as CVCs with anti-infective surfaces, was associated with considerably lower rates of catheter-related BSI. CONCLUSIONS: Expressing risk of IVD-related BSI per 1000 IVDdays rather than BSIs per 100 IVDs allows for more meaningful estimates of risk. These data, based on prospective studies in which every IVD in the study cohort was analyzed for evidence of infection by microbiologically based criteria, show that all types of IVDs pose a risk of IVD-related BSI and can be used for benchmarking rates of infection caused by the various types of IVDs in use at the present time. Since almost all the national effort and progress to date to reduce the risk of IVD-related infection have focused on short-term noncuffed CVCs used in intensive care units, infection control programs must now strive to consistently apply essential control measures and preventive technologies with all types of IVDs.

  • the effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for Intravascular access
    Infection Control and Hospital Epidemiology, 2005
    Co-Authors: Christopher J Crnich, Jeremy A Halfmann, Wendy C Crone, Dennis G. Maki
    Abstract:

    BACKGROUND: Products containing alcohol are commonly used with Intravascular Devices at insertion, to remove lipids from occluded Intravascular Devices used during parenteral nutrition, and increasingly for the prevention and treatment of Intravascular Device-related bloodstream infection. The effects of alcohol on the integrity of Intravascular Devices remain unknown. METHODS: Two types of widely used commercial peripherally inserted central catheters, one made of polyetherurethane and one made of silicone, were exposed to a 70% ethanol lock solution for up to 10 weeks. Mechanical testing was performed to identify force-at-break, stress, strain, modulus of elasticity, modulus of toughness, and wall area of ethanol-exposed and control catheters. RESULTS: No significant differences between exposed and unexposed catheters were identified for any of the mechanical parameters tested except for a marginal reduction in the modulus of elasticity for both polyetherurethane and silicone catheters and minor increases in the wall area of polyetherurethane catheters. CONCLUSIONS: These data indicate that exposure to a 70% ethanol lock solution does not appreciably alter the integrity of selected commercial polyetherurethane and silicone catheters. Given the greatly expanded use of alcoholic solutions with Intravascular Devices of all types, we believe that manufacturers would be well advised to subject their catheters and other Intravascular Devices to formal testing of the type employed in this study.

  • the promise of novel technology for the prevention of Intravascular Device related bloodstream infection i pathogenesis and short term Devices
    Clinical Infectious Diseases, 2002
    Co-Authors: Christopher J Crnich, Dennis G. Maki
    Abstract:

    Intravascular Devices (IVDs) are widely used for vascular access but are associated with substantial risk of development of IVD-related bloodstream infection (BSI). The development of novel technologies, which are based on an understanding of pathogenesis, promises a quantum reduction in IVD-related infections in an era of growing nursing shortages. Infections of short-term IVDs (that is, those in place !10 days), including peripheral venous catheters, noncuffed and nontunneled central venous catheters (CVCs), and arterial catheters, derive mainly from microorganisms colonizing the skin around the insertion site, which most often gain access extraluminally. More-effective cutaneous antiseptics, such as chlorhexidine, a chlorhexidineimpregnated sponge dressing, CVCs with an anti-infective coating, anti-infective CVC hubs, and novel needleless connectors, have all been shown to reduce the risk of IVD-related BSI in prospective randomized trials. The challenge for the future will be to identify new preventative technologies and to begin to adapt more widely those technologies already shown to be efficacious and cost-effective. Reliable vascular access is one of the most essential features of modern medical care. Unfortunately, the Intravascular Devices (IVDs) needed to establish reliable access are associated with a significant potential for producing iatrogenic disease, particularly bacteremia and candidemia [1–3]. More than 250,000 IVD-related (IVDR) bloodstream infections (BSIs) occur in the United States each year [1], each associated with attributable mortality rates of 12%–25% [4, 5], prolongation of hospital stay [4–7], and an added health care cost of $33,000–$35,000 [4–7].

Michele L Pearson - One of the best experts on this subject based on the ideXlab platform.

  • guidelines for the prevention of Intravascular catheter related infections the hospital infection control practices advisory committee center for disese control and prevention u s
    Pediatrics, 2002
    Co-Authors: Naomi P Ogrady, Dennis G. Maki, Mary Alexander, Patchen E Dellinger, Julie L Gerberding, Stephen O Heard, Henry Masur, Rita D Mccormick, Leonard A Mermel, Michele L Pearson
    Abstract:

    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 Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of 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 (ie, 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.

  • guidelines for the prevention of Intravascular catheter related infections centers for disease control and prevention
    MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports Centers for Disease Control, 2002
    Co-Authors: Naomi P Ogrady, Dennis G. Maki, Mary Alexander, Patchen E Dellinger, Julie L Gerberding, Stephen O Heard, Henry Masur, Rita D Mccormick, Leonard A Mermel, Michele L Pearson
    Abstract:

    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 Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of 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.

Nasia Safdar - One of the best experts on this subject based on the ideXlab platform.

  • Intravascular Catheter and Implantable Device Infections in Transplant Patients
    Principles and Practice of Transplant Infectious Diseases, 2019
    Co-Authors: Nasia Safdar, Cybele Lara R. Abad, Dennis G. Maki
    Abstract:

    The use of Intravascular Devices for administration of drugs, fluids, blood products, and nutritional support is essential in patients undergoing transplantation procedures. These Intravascular Devices have a significant potential to produce iatrogenic disease, such as bloodstream infection originating from colonization of the indwelling Intravascular Devices. Over two-thirds of all healthcare-associated bacteremia originate from Devices used for vascular access. Patients undergoing hematopoietic stem cell transplantation, who have inherently compromised immune function because of their cancer and are further incapacitated due to the preparatory pretransplant conditioning regimen or graft-versus-host disease, are particularly prone to Device-related infections. In this chapter, a comprehensive review of epidemiology, disease pathogenesis, clinical presentation, treatment, and prevention of Intravascular Device-related infections is presented.

  • the effect of process control on the incidence of central venous catheter associated bloodstream infections and mortality in intensive care units in mexico
    Critical Care Medicine, 2005
    Co-Authors: Francisco Higuera, Victor D Rosenthal, Pablo Duarte, Javier Ruiz, Guillermo Franco, Nasia Safdar
    Abstract:

    Purpose: To ascertain the effect of an infection control program including process control on intensive care unit (ICU) rates of Intravascular Device (IVD)-associated bloodstream infection (BSI). Setting: Two level III adult ICUs in one public university hospital in Mexico: one medical surgical ICU and one neurosurgical ICU. Population Study: All adult patients admitted to study units who had a central venous catheter (CVC) in place for at least 24 hrs. Methods: A prospective before/after trial in which rates of IVD-associated BSI are determined during a period of active surveillance without process control (phase 1) were compared with rates of IVD-associated BSI after implementing an infection control program applying process control (phase 2). Results: Six hundred five IVD-days*were accumulated in phase 1, and 2824 IVD-days were accumulated during phase 2. Compliance with CVC site care and hand hygiene improved significantly from baseline during the study period: placing a gauze dressing over the catheter insertion site (99.24% vs. 86.69%, respectively; relative risk [RR] = 1.14; 95% confidence interval [Cl] = 1.07-1.22; p =.0000), proper use of gauze for vascular catheter insertion site (97.87% vs. 84.21%, respectively; RR = 1.16; 95% Cl = 1.09-1.24; p =.0000), documentation of the duration of the administration set of the vascular catheter (93.85% vs. 40.69%, respectively; RR = 2.34; 95% Cl = 2.14-2.56; p =.0000), and hand hygiene before contact with the patient (84.9% vs. 62%, respectively; RR = 1.37; 95% Cl = 1.21-1.51; p =.0000). Overall rates of IVD-associated BSI were lowered significantly from baseline rates after implementation of process control (19.5 vs. 46.3 BSIs per 1000 IVD-days, respectively; RR = 0.42; 95% Cl = 0.27-0.66; p =.0001). Overall rates of crude unadjusted mortality were lowered significantly from baseline rates (48.5% vs. 32.8% per 100 discharges, respectively; RR = 0.68; 95% Cl = 0.50-0.31; p =.01). Conclusion: Implementation of an infection control program utilizing education, process control, and performance feedback was associated with significant reductions in rates of IVD-associated BSI and mortality.

Hafizah Y Chenia - One of the best experts on this subject based on the ideXlab platform.