Clinical Decisionmaking

Use of maximal sterile barriers when placing central venous catheters may reduce the risk of catheter-related infections

Central venous catheters (CVCs) provide access for intravenous therapy for patients in intensive care units and for outpatients needing long-term IV therapy. Unfortunately, CVCs are commonly associated with bacterial colonization of the catheter, local infection at the insertion site, and catheter-related bloodstream infection (CR-BSI). While more cumbersome, time-consuming, and expensive than other techniques, use of maximal sterile barriers (MSBs) when placing CVCs may reduce the risk of infections, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11540).

Use of MSBs, which is recommended by experts, requires that the person inserting the CVC wear a head cap, face mask, sterile body gown, and sterile gloves and use a full-size sterile drape around the insertion site. Less-stringent measures usually require only sterile gloves and a small regional sterile drape.

Lead investigator Kent K. Hu, M.D., of the University of Washington, and his colleagues developed a decision model in which a patient could have a CVC placed using either MSB or a less stringent technique. They then calculated total direct medical costs and the incidence of CR-BSI, bacterial colonization of the catheter, and/or death.

Use of MSBs lowered costs from $621 to $369 per catheter insertion and decreased the incidence of CR-BSIs from 5.3 percent to 2.8 percent, catheter colonization with local infection from 5.5 percent to 2.9 percent, and death from 0.8 percent to 0.4 percent. This formal economic evaluation suggests that for every 270 catheters placed with use of MSBs, about $68,000 would be saved, seven episodes of CR-BSI would be avoided, and one death would be prevented. These results strongly support use of MSBs during all nonemergency CVC placements in hospitalized patients, concludes Dr. Hu.

See "Use of maximal sterile barriers during central venous catheter insertion: Clinical and economic outcomes," by Dr. Hu, David L. Veenstra, Pharm.D., Ph.D., Benjamin A. Lipsky, M.D., and Sanjay Saint, M.D., M.P.H., in the November 15, 2004, Clinical Infectious Diseases 39, pp. 1441-1445.

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