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THE PATHOGENESIS OF CRBSI

There are five chief sources of catheter-related bloodstream infection (CRBSI):

The Maximal Barrier Precautions Tray gives you a comprehensive system for helping to prevent each one.

5SourcesCRBSI

Chloraprep

Hi-Lite Orange™
ChloraPrep® applicator

Skin organisms

The bacterial burden can be reduced drastically by using antiseptics such as ChloraPrep (a CDC1A recommendation for prepping insertion sites) or BIOPATCH®;. In at least one study, a 2 percent chlorhexidine solution was superior to a 70 percent isopropyl alcohol solution and 10 percent Povidone-iodine for preventing IV-related infections.1 Arrow Venous Access kits are the only products with Hi-Lite Orange ChloraPrep.

Environmental contamination

Cap Mask

Head-to-toe drape, high-
quality gown, mask and cap

Approximately 259,000 CVC-associated bloodstream infections occur in the U.S. each year.2 Each incident can cost a facility an average of $26,839 in added expenses, and prolongs the length of stay seven to nine days.3

However, at least two studies prove that maximal barrier precautions significantly reduce the likelihood of bloodstream infection.4,5 For example, Raad et al. found that the chance of infection was 6.3 times higher without maximal barrier precautions.

As important as using maximal barrier precautions is, as soon as the drape, gown, mask and cap are in the trashcan, the catheter is open to contamination—which is reflected in the fact that 26 percent of catheter-related bloodstream infections appear to be derived from internal lumen contamination.6

Post-placement subcutaneous tract infection

Catheter In Box

ARROWg+ard Blue
PLUS® catheter

Despite the use of barrier protection and surface antiseptics, bacteria can still gain access to the subcutaneous tract. Chlorhexidine and silver sulfadiazine impregnated into a catheter's surface "prep" the subcutaneous tract with a burst of antimicrobials at the time of insertion, then continue to have an inhibitory effect in the subcutaneous tract for weeks.7

ARROWg+ard Blue PLUS catheters feature chlorhexidine impregnated into both the exterior and interior catheter surfaces. ARROWg+ard Blue PLUS catheters also have three times more chlorhexidine on their exterior surfaces than our first-generation antimicrobial catheters.

Intraluminal contamination

As many as 26 percent of catheter-related bloodstream infections appear to be derived from internal lumen contamination.6 This occurs through repeated access into the system and/or breaks in technique during which bacteria gain access to the internal lumens of the catheter. Antimicrobial catheters protected on their intraluminal surface have every lumen protected with chlorhexidine to significantly reduce colonization. ARROWg+ard Blue PLUS catheters are the only antimicrobial catheters that have catheter hub and extension line protection as well.8

Hematogenous seeding

Occurs when bacteria attach to the catheter from a distant site. Antimicrobial catheters have been shown effective at significantly reducing colonization of their surface.9,10

REFERENCES

1 Maki, D., Ringer, M., Alvarado, C.J." Prospective Randomized Trial of Povidone-iodine, Alcohol and Chlorhexidine for Prevention of Infection Associated With Central Venous and Arterial Catheters." Lancet, August 1991, Vol. 338, pp. 339–343.

2 O'Grady, N.P., Alexander, M., Dellinger, E.P., Gerberding, J.L., Heard, S.O., Maki, D.G., Masur, H., McCormick, R.D., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A., Weinstein, R.A. "Guidelines for the Prevention of Intravascular Catheter-Related Infections." Centers for Disease Control, August 9, 2002, Vol. 51, No. RR10, pp. 7–8.

3 Murphy, D., Whiting, J. "Dispelling the Myths: The True Cost of Healthcare-Associated Infections." An APIC Briefing, February 2007.

4 Raad, I.I., Hohn, D.C., Gilbreath, B.J., et al. "Prevention of Central Venous Catheter-Related Infections by Using Maximal Sterile Barrier Precautions During Insertion." Infection Control Hospital Epidemiology, 1994, Vol. 15 (4 Pt 1), pp. 231–238.

5 Mermel, L.A., McCormick, R.D., Springman, S.R., Maki, D.G. "The Pathogenesis and Epidemiology of Catheter-Related Infection With Pulmonary Artery Swan-Ganz Catheters: A Prospective Study Utilizing Molecular Subtyping." American Journal of Medicine, 1991, Vol. 91 (3B), pp. 197S–205S.

6 Safdar, N., Maki, D.G. "The Pathogenesis of Catheter-Related Bloodstream Infection With Noncuffed Short-Term Central Venous Catheters." Intensive Care Medicine, January 2004, Vol. 30, No. 1, pp. 62–67.

7 Fey, P.D., Mathews, K.I., Peterson, D.K., Iwen, P.C., Hinrichs, S.H., Rupp, M.E., "Inhibitory Effect of Explanted Chlorhexidine-Silver Sulfadiazine Impregnated Central Venous Catheters on Staphylococcus Epidermis." Presented at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17–20, 2000, Toronto, Ontario, Canada.

8 Spangler, D., Moss, S. "In Vitro Assessment of Antimicrobial Activity of Three Commercially Available Central Venous Catheters." Department of Applied Research, Arrow International, Inc., 2007.

9 Maki, D.G., Stolz, S.M., Wheeler, S., Mermel, L.A. "Prevention of Central Venous Catheter-Related Bloodstream Infection With an Antiseptic-Impregnated Catheter: A Randomized, Controlled Trial." Annals of Internal Medicine, August 15, 1997, Vol. 127, Issue 4, pp. 257–266.

10 Rupp, M.E., Lisco, S.J., Lipsett, P.A., Perl, T.M., Keating, K., Civetta, J.M., Mermel, L.A., Lee, D., Dellinger, P.E., Donahue, M., Giles, D., Pfaller, M.A., Maki, D.G., Sherertz, R. "Effect of a Second-Generation Venous Catheter Impregnated With Chlorhexidine and Silver Sulfadiazine on Central Catheter-Related Infections: A Randomized, Controlled Trial." Annals of Internal Medicine, Vol. 143, No. 8, October 18, 2005, pp. 570–581.

Hi-Lite Orange™ is a trademark of Enturia, Inc.

ChloraPrep® is a registered trademark of Enturia, Inc.

BIOPATCH® is a registered trademark of Johnson & Johnson Corporation.

PATENTS: ARROWg+ard® / ARROWg+ard Blue PLUS®: U.S. Patent Nos. 6,706,024 and 6,872,195

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