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Monday, March 28, 2011
What Would Semmelweis Have Recommended?
Let’s face it; in the 21st century, catheter-related bloodstream infections are still a major threat to the health and welfare of hospitalized patients!(reference 1) Anesthesia patient care presents multiple “opportunities” for practitioners to violate the body’s protective barriers and introduce infectious agents into a patient’s bloodstream via vascular access and monitoring catheters. You may figuratively scour the literature and recommendations from manufacturers, but you won’t find much substantive guidance on how to actually scour the catheters we use as we administer intravenous medications and monitor hemodynamic parameters during anesthesia or provide care in an intensive care unit.(reference 2)

A stunning visual in an “Images in Anesthesiology” manuscript in the April issue of Anesthesiology provides graphic “evidence” that the longer you scrub the hub, the better able you are to clean contaminants off of the injection site.(reference 3) I think this concept, discovered more than 150 years ago by Semmelweis, was made crystal clear at our medical school graduation ceremonies a few years ago in remarks offered to the new physicians by our Senior Professor of Microbiology, Helen Davies. She encouraged the graduates to follow 3 rules in their future practice of medicine: “1) Listen to your patients; 2) Take care of yourself; and 3) Wash your hands!” Whether given by Semmelweis or Davies, the advice is the same: Scrub your hands and catheters! What’s your protocol for keeping injection ports decontaminated? Send us a comment so we all can learn what works well for you.

References
1. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355: 2725-32

2. Menyhay SZ, Maki DG: Preventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors. Am J Infect Control 2008; 36: S174.e1-5

3. Lockman JL, Heitmiller ES, Ascenzi JA, Berkowitz I: Scrub the hub! Catheter needleless port decontamination. Anesthesiology 2011; 114: 958

Posted by Alan Jay Schwartz, M.D.,MSEd
Alan Jay Schwartz

About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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