The prevention of central venous catheter-related sepsis

Intravascular catheters continue to be a major source of sepsis which range from localised inflammation at the site of insertion to septicaemia. There are two main approaches which have been taken in an attempt to prevent these infections. These can be divided into the patient and the catheter. Approaches for prevention with patients include improved aseptic techniques, appropriate choice of antiseptic skin preparations, use of semi-occlusive dressings and cleaning schedules when using the devices. Catheters have also been developed to reduce the incidence of these infections. These include the production of polymers with smooth, anti-adhesive coatings, eg Hydromer, and more recently the introduction of devices which are either coated with antiseptics or antimicrobials. The antimicrobial coatings include antibiotics such as rifampicin and doxycycline or antiseptics, for example benzalkonium chloride or chlorhexidine. The efficacy of these approaches will be reviewed based on both laboratory and clinical studies. The treatment of intravascular catheter-related sepsis depends primarily on establishing the diagnosis. When the diagnosis has been made treatment ranges from the use of antimicrobials alone to removal of the device. More recent approaches have included the use of antibiotic locks within the catheters. Treatment schedules will also be reviewed.