THE CASE FOR MAXIMAL BARRIER PRECAUTIONS

Over 200,000 patients per year develop a CRBSI, and as many as 20 percent of these cases result in death.¹

But institutions can virtually eliminate the chief sources of CRBSIs, says the Institute for Healthcare Improvement (IHI),² with:

• Full sterile barrier precautions
• Consistent basic sanitation
• Proven, evidence-based infection-prevention tools

Maximal Barrier Precautions Defined

According to the IHI, “… maximal barrier precautions means strict compliance with hand hygiene and wearing a cap, mask, sterile gown, and gloves. The cap should cover all hair and the mask should cover the nose and mouth tightly. These precautions are the same as for any other surgical procedure that carries a risk of infection. For the patient, applying maximal barrier precautions means covering the patient from head to toe with a sterile drape, with a small opening for the site of insertion."²

The Risk—and Reward

At least two studies of central line insertions have documented the risk of not applying maximal barrier precautions:

• Mermel et al. demonstrated that the odds ratio was 2.2 times greater for infection without maximal barrier precautions.¹
• Raad et al. demonstrated a 6.3 times greater likelihood for infection without precautions. ¹

Conversely, the adjacent chart demonstrates how institutions can dramatically reduce their rates of CRBSI by employing maximal barrier precautions as part of the IHI’s “CVC bundle”: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection and daily review of line necessity, with prompt removal of unnecessary lines.

Berenholtz, S.M., Pronovost, P.J., Lipset, P.A., et al. “Eliminating Catheter-Related Bloodstream Infection in the Intensive Care Unit.” Critical Care Medicine, 2004, Vol. 32, pp. 2014–2020.