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10/3/2002

Infection Control Guidelines Apply to Home Care Setting

Kate Traynor

Updated guidelines (PDF) issued in August by the Centers for Disease Control and Prevention (CDC) include information on preventing catheter-related infections in patients receiving home-infusion therapy.

The guidelines state that, regardless of the health care setting, the routine admixture of injectable fluids should be performed by pharmacy staff using aseptic techniques and a laminar-airflow hood. Also, the filtration of medications or infusates in the pharmacy is preferable to the use of inline filters at the patient's bedside.

CDC advises against the use of inline filters to reduce the risk of catheter-related infections. The agency's guidelines do not address the use of inline filters to remove glass particles that may remain after an additive is withdrawn from an ampul.

According to the guidelines, single-dose vials of medications and additives should be used whenever possible to prepare intravenous admixtures. Repeatedly puncturing the diaphragm of a single-dose vial or combining leftover contents can contaminate the product and should be avoided.

Needleless intravascular catheter systems, which are designed to reduce injuries among health care workers, are briefly discussed in the guidelines. CDC noted that the use of such devices in accordance with manufacturers' instructions does not affect the incidence of catheter-related bloodstream infections.

Catheter type, insertion site, and insertion technique should be selected with the goal of exposing the patient to the lowest risk of infection or other complications for the type and duration of therapy.

The guidelines recommend the use of a multidisciplinary approach to reducing catheter-related infections. In addition to providing infection-control education to all members of the health care team, CDC recommends that infection-reduction programs enlist the help of patients who are able to assist in the care of their catheters. In particular, patients should be asked to tell a health care provider about any discomfort or change that occurs at the catheter site.

Also mentioned in the guidelines is the use of surveillance to determine the frequency of catheter-related bloodstream infections and to monitor infection trends. The surveillance process also includes investigation of all unexpected life-threatening events and deaths, according to CDC.

Although the guidelines do not address the creation of infection-surveillance systems in home care settings, the Association for Professionals in Infection Control and Epidemiology in 2000 released draft definitions (PDF) for infection surveillance by home care programs.

In all health care settings, proper hand hygiene plays a critical role in limiting infections. The guidelines call for proper hand washing and the use of aseptic technique when inserting and maintaining catheters. CDC recommends that health care workers use a waterless, alcohol-based foam or gel product or an antimicrobial soap and water for hand cleansing.