Bacteriology, safety and prevention of infection associated with continuous intravenous infusions

There are over 50,000 intravascular catheter-associated bloodstream infections in the United States each year; globally, the number of these infections is likely to be much higher. At least half of these bloodstream infections are caused by staphylococci. The source of most pathogens causing endemic catheter-associated bloodstream infections is the catheter insertion site or the catheter hub, whereby microbes migrate into the bloodstream along the outside or inside of the catheter, respectively. The pathogenesis of epidemic intravascular catheter-related bloodstream infections is quite different. Epidemic bloodstream infections are due to manufacturer-related contamination or contamination that occurs at the location of catheter use, such as the hospital. These epidemics have most often been traced to contamination of intravenous solutions such as hyperalimentation or medications, blood products, contaminated cutaneous antiseptics or faulty decontamination of reusable devices. The prevention of infection associated with continuous intravenous infusion of factor VIII poses a number of challenges. Assurances of the sterility of the product is of paramount importance, as is proper storage of the product prior to use. Prevention of infection will further require particular attention to the conditions surrounding insertion of the catheter, including the optimal site of insertion, maximal barrier precautions and optimal disinfection of the insertion sites, and also to conditions surrounding maintenance of the device after insertion, including proper disinfection and aseptic techniques when manipulating the catheter hub, daily assessment of the insertion site, and maintaining scheduled changes of the intravenous tubing. With proper precautions, the risk of serious infection associated with a continuous infusion of factor VIII should be minimal.