Infectious Diseases II
| (c) | Daily chlorhexidine baths for patients to reduce colonization |
|---|---|
| (d) | Use of a systemic process or checklist at the time of insertion to ensure adherence to the |
proper insertion technique
| (e) | Alcohol-based chlorhexidine skin cleanser for skin preparation |
|---|---|
| (f) | Perform hand hygiene during insertion, care, and maintenance of the catheter. |
| (g) | Cleanse catheter hubs before accessing. |
| (h) | Routine post-insertion site care |
| (i) | Routine replacement of administration sets not used for blood, blood products, or lipid |
formulations can be performed at intervals up to 7 days.
(j) Chlorhexidine-containing site/catheter dressings
ii.
Additional approaches
| (a) | Use antiseptic or antimicrobial-impregnated catheters. |
|---|---|
| (b) | Use antimicrobial ointments for hemodialysis catheter insertion sites. |
| (c) | Use antiseptic hub cover or port protector. |
| (d) | Antimicrobial lock therapy |
| (e) | Use recombinant tissue plasminogen activating factor weekly if dialysis is performed |
through CVC.
Use appropriate techniques for catheter insertion (e.g., skin preparation and maximal sterile barrier
precautions) and management (e.g., daily site care, routine site evaluation for local erythema).
Minimize the use of CVCs. Pharmacists may provide reminders as part of a multidisciplinary
effort to minimize the placement and duration of venous catheters.
Consider antibiotic lock therapy in patients with limited venous access or a history of catheter-
related bloodstream infections.
| d. | Do not use systemic antibiotic prophylaxis. |
|---|
Antimicrobial/silver-impregnated catheter should be considered in patients with an anticipated
catheter duration greater than 5 days if rates of catheter-related bloodstream infections have not
decreased despite the implementation of a comprehensive prevention strategy.
Diagnosis, management, and treatment of CLABSIs: See Infectious Diseases I chapter.
Bacterial meningitis is a neurologic emergency involving mild to severe inflammation of the meningeal
layers encasing the central nervous system (CNS). Cerebrospinal fluid (CSF) is intimate to the meninges
and serves as both a medium for pathogen growth and a diagnostic fluid.
or hospitalization.
Health care–associated or nosocomial meningitis is an infection related to invasive procedures,
including craniotomy, internal or external ventricular catheters, lumbar puncture, intrathecal medication
administration, and/or spinal anesthesia. Additional causes include complicated cranial trauma,
traumatic brain injury, and hematogenous spread in patients with hospital-acquired bacteremia.