[Central venous catheter-related infection]

Area of Science:

• Infectious Disease Epidemiology
• Clinical Interventions
• Patient Safety

Context:

• Current guidelines recommend maximal sterile barrier precautions (MSBP) for central venous catheter insertion to prevent catheter-related bloodstream infections (CRBSI).
• Existing recommendations are largely based on limited evidence from a single randomized controlled trial (RCT) involving outpatient chemotherapy patients.
• The applicability of MSBP across diverse clinical settings, particularly for hospitalized surgical patients, remains insufficiently evaluated.

Purpose:

• To evaluate the effectiveness of maximal sterile barrier precautions (MSBP) compared to standard sterile barrier precautions (SSBP) in preventing CRBSI.
• To assess CRBSI rates in surgical patients admitted to general wards using a multi-institutional randomized controlled trial (RCT).

Summary:

• A multi-institutional RCT compared MSBP (cap, mask, sterile gown, sterile gloves, large sterile sheet) with SSBP (sterile gloves, small sterile drape) during central venous catheter insertion in surgical patients.
• No significant difference in CRBSI rates was observed: 2.4% in the MSBP group (5/211) versus 2.8% in the SSBP group (6/213), with a P-value of 0.77.
• The study did not demonstrate superior CRBSI prevention with MSBP in this patient population.

Impact:

• Findings suggest that MSBP may not be more effective than SSBP for CRBSI prevention in general surgical ward patients.
• Results highlight the need for further RCTs in various clinical settings to establish definitive evidence on MSBP efficacy.
• This research contributes to the ongoing debate on optimal practices for preventing healthcare-associated infections.