Infection Control & Hospital Epidemiology
were performed in our hospital microbiology lab using the roll- plate method.10 Cultures growing at least 15 colony-forming units (CFUs) were considered colonized ACs. We studied 100 AC tips removed from 97 patients that had been
inserted from March 4, 2016, to June 24, 2016. The insertions were predominantly conducted by our attending anesthesiologists or nurse anesthetists (~8 different providers for 90% of the AC inser- tions). Providers did not have additional training, and no quality improvement project was associated with the study. The mean patient age was 67 years (range, 26–86 years). Overall, 42 patients had coronary artery bypass graft surgery, 36 had aortic valve replacement, 9 had mitral valve replacement, 9 had aortic aneurism or dissection repair, 1 had transcutaneous aortic valve replacement, and 1 had a surgical maze procedure. Also, 3 of the surgeries were emergent, nonelective cases in hemodynamically unstable patients. Moreover, 98 ACs were inserted in the operating room or pre- operative holding unit, and 2 were inserted in the CTICU. Overall, 98 ACs were inserted in the radial artery and 2 were inserted in the femoral artery. The ACs remained in situ a mean of 5 days (range, 1–11 days). Only 1 radial AC, which was inserted in the operating room, was colonized; it grew 15–50 CFUs of coagulase-negative staphylococci. Two catheters had <15 CFUs, consistent with catheter contamination during catheter removal (one AC had 1 CFU of Staphylococcus epidermidis, and the other AC had 3 CFUs of Micrococcus and 3 CFUs each of 2 different Bacillus species). All other catheters had no growth. There were no AC-related infections. Only 1% of the ACs placed in the operating room or pre-
operative holding unit were colonized despite most AC insertions with sterile gloves, mask, hat, and a small sterile drape. This was an unexpected finding based on prior published studies.4 Our findings may reflect the fact that the majority of ACs were placed in the operating room or preoperative holding unit, rather than an ICU, with sterile gloves and alcoholic chlorhexidine for cuta- neous antisepsis, which was not the case in many previously pub- lished studies. In conclusion, the very low incidence of peripheral AC colo-
nization we observed may be due to the controlled settings in which the catheters were placed (ie, predominantly in the oper- ating room), catheter maintenance practices at our institution, or perhaps the low risk in cardiac surgical patients. We believe that the current practices with less than maximum barrier precautions, namely using a small drape rather than a large sheet drape in this patient population, presents a low risk of AC infection. However,
1009
the small number of ACs in this project limits the generalizability of our findings.
Acknowledgments. The authors acknowledge the gracious assistance of the physicians, physician assistants, nurse practitioners, and nurses of our cardi- othoracic ICU, and the assistance of our anesthesiology staff in conducting this study.
Financial support. This work was funded by an unrestricted Clinical Excellence Grant from the CareFusion Foundation.
Potential conflicts of interest. Dr Levinson reports the grant from the Carefusion Foundation. Dr Mermel, in addition to the Carefusion Foundation grant, reports having served as a consultant to Bard, Marvao Medical, Applied Silver, PuraCath, and Nobio. All other authors report no conflicts of interest relevant to this article.
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