Rhode Island Hospital Researchers Find Variability in Compliance With CDC Guidelines

According to a survey conducted by Rhode Island Hospital researchers, there is significant variability regarding how clinicians manage catheters placed in the arteries of patients in intensive care units. Some practices may increase risk of infection associated with these catheters. Fewer than half of those surveyed complied with current Centers for Disease Control and Prevention (CDC) infection prevention guidelines for arterial catheter insertions. The study was published today in Critical Care Medicine.

"Barrier precautions are employed inconsistently by critical care clinicians across the nation, and such individuals underestimate the infection risks posed by arterial catheters," says Leonard A. Mermel, DO, ScM, medical director of the epidemiology and infection control department at Rhode Island Hospital and co-author of the study. "Every effort should be made to prevent such infections since they lead to increased cost, length of stay and morbidity."

In 2011 the CDC published recommendations specifying that clinicians don sterile gloves, a surgical cap and surgical mask, and use a small sterile drape when these catheters are inserted into the artery of a patient. Of the 1,265 study respondents, only 44 percent reported using the CDC-recommended barrier precautions during insertion and only 15 percent reported using full barrier protections.

"There appears to be a significant deviation from clinical guidelines regarding a very commonly performed procedure in critically ill patients," says Andrew Levinson, MD, MPH, corresponding author. "Bloodstream infections are largely preventable, and if the survey results mirror the clinical practice in the U.S., there's work to be done in reducing risk of such infections."

The responses were anonymous. Survey participants consisted of members of the Society of Critical Care Medicine, specifically attending physicians, fellows, residents, nurse practitioners, physician assistants, registered nurses and respiratory therapists.

All Lifespan hospitals are fully compliant with the CDC's recommendations. They include Rhode Island Hospital and its pediatric facility, Hasbro Children's Hospital; The Miriam Hospital; and Newport Hospital.

The catheter is commonly used in intensive care medicine and anesthesia to monitor the blood pressure and sample blood gasses directly from the artery. Approximately eight million arterial catheters are placed in U.S. hospitals every year. This type of catheter is a potential source of bloodstream infections because it provides a direct, indwelling, and frequently accessed pathway between the skin and bloodstream.

There was no outside funding for this study. Andrew Levinson's and Leonard Mermel's principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. They also have academic appointments at Alpert Medical School of Brown University. Other Lifespan researchers contributing to the study were: David M. Cohen, MD, Gerardo P. Carino, MD, PhD, Daithi S. Hefferman, MD, Stephanie N. Lueckel, MD, Dorothy Skierkowski, MA, Jason T. Machan, PhD, and Jeffrey Mazer, MD, who is now affiliated with Lovelace Medical Group in Albuquerque, N.M.

Source: Rhode Island Hospital, Lifespan