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Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.131
Acknowledgments. The authors thank the Society of Healthcare Epidemiology of America Research Network members who kindly responded to our survey.
Financial support. No financial support was provided relevant to this article.
Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.
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Peripheral arterial catheter colonization in cardiac surgical patients
Andrew T. Levinson MD, MPH1,2, Kimberle C. Chapin MD1-3, Lindsay LeBlanc BS3
and Leonard A. Mermel DO, ScM1,4 1Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 2Division of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital and Miriam Hospital, Providence, Rhode Island, 3Department of Pathology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island and 4Division of Infectious Diseases and Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, Rhode Island.
(Received 2 February 2018; accepted 24 April 2018; electronically published June 26, 2018)
Arterial catheters (ACs) are commonly inserted in critically ill patients for continuous blood pressure monitoring. They are most commonly inserted in the radial artery of the upper extremity and should not be confused with pulmonary artery catheters. Pub- lished studies have shown that the risk of bloodstream infections from infected ACs is similar to that from central venous catheters. The incidence density of AC-related bloodstream infections is 0.9–3.4 per 1,000 catheter days, which is 40%–90% of the inci- dence density of central venous catheter-related bloodstream infections.1–5 In 2011, the CDC released updated infection pre- vention guidelines for intravascular catheters, recommending use of a cap, mask, sterile gloves, and a small sterile fenestrated drape for peripheral AC insertion.6 However, there is significant prac- tice variation regarding barrier precautions utilized for AC catheter insertion and low adherence to these guidelines.7 The primary aim of our proof-of-concept project was to
determine the potential infectious risk of peripheral ACs inserted in the operating room or preoperative holding unit using less than maximal barrier precautions (ie, use of sterile gloves and a small drape rather than a large sheet drape that would keep ancillary instruments sterile when several inches away from the insertion
Author for correspondence: Dr LeonardMermel, Division of Infectious Diseases, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903. E-mail:
lmermel@lifespan.org Cite this article: Levinson AT, et al. (2018). Peripheral arterial catheter colonization
in cardiac surgical patients. Infection Control & Hospital Epidemiology 2018, 39, 1008–1009. doi: 10.1017/ice.2018.127
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
site). Our hypothesis was that we would find a relatively high incidence of AC catheter colonization. Because several studies have demonstrated that the risk of catheter colonization correlates with the risk of catheter-related bloodstream infection,8,9 we used AC colonization as our outcome measure. This project was carried out at Rhode Island Hospital, a tertiary-
care teaching hospital licensed for 719 beds. Patients were included in the study if they were undergoing cardiothoracic surgery and were admitted to our 16-bed cardiothoracic surgery intensive-care unit (CTICU) directly from the operating room with their ACs in situ. In the operating room, the insertion site was prepped with alcoholic chlorhexidine (Chlora Prep TM; Becton Dickinson, Franklin Lakes, NJ), and ACs were preferentially placed in the radial artery of an upper extremity 0–5cm proximal to the patient’swrist by an anesthesiologist or nurse anesthetist using gloves, cap, mask, and a small sterile drape (46 by 66 cm). For patients in our cardi- othoracic intensive care unit (CTICU) whose ACs were removed and who required insertion of a new AC, this procedure was carried out by physician’s assistants using an AC insertion kit which included a hat, mask, sterile gloves, gown, sterile drape (76×91 cm) with 7.6 cm fenestration, and alcoholic chlorhexidine (Chlora Prep TM; Becton Dickinson, Franklin Lakes, NJ). Such catheters were preferentially inserted in the radial artery. We included patients who had>1 AC placed during their hospitalization. We prospectively obtained AC tip cultures when ACs inserted
in the operating room or the CTICU were removed from patients as determined by the CTICU staff. Arterial catheter tip cultures
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