Update: Catheter-related bloodstream infection rates in relation to clinical practice and needleless device type

Catheter-related bloodstream infection (CR-BSI), the third most common healthcare-associated infection (HAI) in the intensive care unit, is a significant issue for infection prevention and control professionals. CR-BSIs result in significant increases in morbidity, mortality, length of hospital stay and financial costs and therefore must be regarded as a failure in patient care. Among the factors affecting CR-BSI rates are the type of needleless access device, access device disinfection methods, compliance with infection prevention and control procedures, clinician training and ongoing education, the number of individuals accessing the device, and patient characteristics. Consistent implementation of institutional infection prevention and control protocols has demonstrated a reduction in CR-BSI incidence. Recent studies in the literature on needleless access devices indicate mechanical valve access devices appear to be associated with an increased BSI rate compared to split septum access devices; however, the reasons have not been completely elucidated. Reduction in CR-BSI rates depends on adherence to best practice in infection prevention; selection of appropriate needleless intravenous (IV) infusion systems; and routine BSI surveillance, with timely dissemination of data within the institution. This article discusses the links amongst CR-BSIs and adherence to aseptic techniques for catheter insertion, access device disinfection and maintenance, and differences in needleless access device technologies. A review of patient-related factors is beyond the scope of this article.