Device Associated Infections, An Issue of Infectious Disease Clinics

Preeti N. Malani

Description

Optimal management of device associated infections requires a collaborative approach among surgical and medical specialists—a need that is central to this issue of Infectious Diseases Clinics of North America. In addition to the epidemiology, management, and prevention of commonly encountered device associated infections, each review offers technical background on specific devices and related operative procedures. Areas of ongoing investigation are highlighted including innovative concepts for the prevention of biofilm formation and biofilm directed therapeutics. Emerging issues related to reuse of medical devices in resource limited settings are also considered.

Sujets

• Infectious Diseases
• Medical
• Médecine

Informations

• Publié par: Saunders
• Date de parution: 28 mars 2012
• Nombre de lectures: 0
• EAN13: 9781455742875
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Infectious Disease Clinics of North America , Vol. 26, No. 1, March 2012
ISSN: 0891-5520
doi: 10.1016/S0891-5520(11)00105-X

Contributors
Infectious Disease Clinics of North America
Device Associated Infections
Preeti N. Malani, MD, MSJ
Department of Internal Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Michigan and Ann Arbor Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, 2215 Fuller Road, 111-I, 8th Floor, Ann Arbor, MI 48105, USA
ISSN  0891-5520
Volume 26 • Number 1 • March 2012

Contents

Contributors
Forthcoming Issues
Device-Associated Infections
New Developments in the Prevention of Intravascular Catheter Associated Infections
Urinary Catheter-Associated Infections
Management and Prevention of Prosthetic Joint Infection
Vascular Graft Infections
Cardiovascular Implantable Electronic Device Associated Infections
Left Ventricular Assist Device–Associated Infections
Central Nervous System Device Infections
Breast Implant Infections
Infectious Complications of Dialysis Access Devices
Medical Device–Associated Infections in the Long-Term Care Setting
Reuse of Medical Devices: Implications for Infection Control
Novel Approaches to the Diagnosis, Prevention, and Treatment of Medical Device-Associated Infections
Index
Infectious Disease Clinics of North America , Vol. 26, No. 1, March 2012
ISSN: 0891-5520
doi: 10.1016/S0891-5520(11)00107-3

Forthcoming Issues
Infectious Disease Clinics of North America , Vol. 26, No. 1, March 2012
ISSN: 0891-5520
doi: 10.1016/j.idc.2011.09.013

Preface
Device-Associated Infections

Preeti N. Malani, MD, MSJ
Department of Internal Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Michigan and Ann Arbor Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, 2215 Fuller Road, 111-I, 8th Floor, Ann Arbor, MI 48105, USA
E-mail address: [e-mail]


Preeti N. Malani, MD, MSJ, Guest Editor
Each year hundreds of thousands of patients undergo implantation of various medical devices, including prosthetic joints, urinary and venous catheters, and left ventricular assist devices. Although these technologies can improve quality and sometimes even quantity of life, infection remains a potentially devastating complication. Besides significant morbidity and functional impairment, device-associated infection presents a considerable economic burden, accounting for hundreds of millions of dollars in excess health care costs. Despite improved diagnostics and an expanding antimicrobial armamentarium, successful treatment of device-associated infection remains a vital clinical challenge.
From an infectious diseases standpoint, the most predictably effective approach to manage an infected device is to simply “take it out”; however, some devices cannot be easily removed and some patients are not candidates for additional operative procedures. Although treatment with antimicrobials alone is generally inadequate given the physiology of biofilms, long-term suppressive therapy can sometimes palliate symptoms. The need to strike a fine balance between the desire for clinical cure and the need to maintain physical function and quality of life is the very quintessence of device infection. These concerns are perhaps most critical among older adults, who receive a disproportionate number of devices and experience a larger number of infectious complications. As such, an ongoing discussion of the overall goals of care must be an integral part of every treatment plan.
Dramatic improvements in engineering and design help make device development one of the most dynamic fields in medicine. Thirty years ago, cardiac surgeons (not cardiologists) placed implantable cardioverter-defibrillators via thoracotomy; today cardiologists (not cardiac surgeons) can use a percutaneous approach to place short-term left ventricular assist devices. With rapidly evolving technology comes the need for infectious diseases specialists to maintain an understanding of the many technical nuances intrinsic to new devices.
Optimal management of device-associated infections requires a collaborative approach among surgical and medical specialists—a need that is central to the current issue of Infectious Diseases Clinics of North America . This cooperative spirit is reflected in the authorship, which includes infectious diseases experts as well as authorities in surgical (vascular, orthopedic, plastics, and cardiac) and nonsurgical (nephrology, cardiology, geriatrics) specialties.
Collectively, this issue of the Clinics examines best practices for these complex infections. In addition to the epidemiology, management, and prevention of commonly encountered device-associated infections, each review offers technical background on specific devices and related operative procedures. Areas of ongoing investigation are highlighted, including innovative concepts for the prevention of biofilm formation and biofilm-directed therapeutics. Emerging issues related to reuse of medical devices in resource-limited settings are also considered.
As device use continues to burgeon, the role of the infectious disease consultant will remain indispensable. The authors and I hope that you find this issue of the Clinics to be a practical and up-to-date resource.
Infectious Disease Clinics of North America , Vol. 26, No. 1, March 2012
ISSN: 0891-5520
doi: 10.1016/j.idc.2011.09.002

New Developments in the Prevention of Intravascular Catheter Associated Infections

Angela L. Hewlett, MD, MS a , * , Mark E. Rupp, MD a , b
a Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA
b Department of Healthcare Epidemiology, University of Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198, USA
* Corresponding author.
E-mail address: [e-mail]

Abstract
Central line-associated bloodstream infections (CLA-BSI) are one of the leading causes of healthcare-associated infections, resulting in significant morbidity and substantial excess cost. There is a growing recognition that most CLA-BSIs are preventable. Elimination of preventable CLA-BSI is the focus of a recently released CDC Guideline. Universal preventative measures include collaborative performance improvement using checklists and bundles, education of persons who insert and maintain catheters, maximal sterile barrier precautions, and chlorhexidine skin preparation. Technologic innovations including coated catheters, antimicrobial impregnated dressings, and antimicrobial lock solutions should be considered if the rate of CLA-BSI is not acceptable after application of universal precautions.

Keywords
• Bloodstream infection • Central venous catheter • Intravascular catheter • Catheter-related bloodstream infection
Central line–associated bloodstream infections (CLA-BSIs) are one of the leading causes of health care–associated infections (HAI). These infections result in significant morbidity along with excess health care costs. In the past, the majority of central venous catheters (CVCs) were used only in intensive care units (ICUs). Currently CVCs are present in multiple health care settings, including long-term care facilities, home health care, and outpatient hemodialysis centers.
There is a growing recognition that many CLA-BSIs are preventable through the use of existing technology and clinical practice techniques. The ubiquitous nature of these catheters, along with the attributable morbidity, mortality, and excess costs of CLA-BSI, has led to concerted infection-control efforts aimed at preventing CLA-BSIs. The epidemiology, pathogenesis, and new developments in the prevention of CLA-BSI are discussed here. The diagnosis and management of CLA-BSI are beyond the scope of this article, and have been recently reviewed. 1

Epidemiology
The National Healthcare Safety Network (NHSN) collects data on the incidence of CLA-BSI in the United States. According to the NHSN data from 2006 to 2008, the risk of CLA-BSI varies by the type of ICU or inpatient setting. The pooled mean CLA-BSI rates from range from 0.8 per 1000 catheter-days (inpatient rehabilitation wards) to 5.5 per 1000 catheter-days (critical care burn units). 2 These rates relate to surveillance, and may overestimate the true incidence of CLA-BSI because all bloodstream infections do not originate from the CVC. However, the NHSN rates are risk adjusted, and are used by facilities for benchmarking of individual CLA-BSI rates. Other factors found to influence CLA-BSI rates are patient-related factors including severity of illness, catheter-related factors such as the type of catheter used and site of catheter placement, and institutional factors including the number of beds at the facility and academic affiliation. 3
In 2001, the Centers for Disease Control and Prevention (CDC) estimated that 43,000 CLA-BSIs occurred in ICUs across the United States. 4 In 2009, the estimated number of CLA-BSIs in ICUs in the United States decreased to 18,000, representing a 58% decrease in ICU CLA-BSIs during a 9-year period. Along with a reduction in morbidity and mortality, this decrease also results in substantial cost savings because each CLA-BSI has been estimated to increase health care costs by $16,550. 4 These reductions are largely thought to be due to new developments