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Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection

  • Md Abu Choudhury
    Correspondence
    Address correspondence to Md Abu Choudhury, Vet Med, MS, PhD, MNursSt, University of Queensland, School of Medicine, UQ Centre for Clinical Research, Building 71/918 RBWH Herston, Brisbane, QLD 4029, Australia.
    Affiliations
    University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia

    Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia

    Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia

    Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia
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  • Hanna E. Sidjabat
    Affiliations
    University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
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  • Hosam M. Zowawi
    Affiliations
    University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia

    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia and World Health Organization Collaborating Centre for Infection Prevention and Control, Riyadh, Saudi Arabia
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  • Nicole Marsh PhD
    Affiliations
    Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia

    Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia

    Royal Brisbane and Women's Hospital, Brisbane, Australia
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  • Emily Larsen
    Affiliations
    Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia

    Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia

    Royal Brisbane and Women's Hospital, Brisbane, Australia
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  • Naomi Runnegar PhD
    Affiliations
    Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia

    Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia

    Princess Alexandra Hospital, Brisbane, Australia
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  • David L. Paterson
    Affiliations
    University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
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  • David J. McMillan
    Affiliations
    Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia
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  • Claire M. Rickard
    Affiliations
    Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia

    Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia

    Royal Brisbane and Women's Hospital, Brisbane, Australia
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      Highlights

      • The skin at the catheter insertion sites is the potential source infection.
      • Bacteria colonized in skin sites and matching catheters were clonally related.
      • The bacterial species isolated from catheter tips and skin sites were diverse.
      • Improved topical antiseptics and catheter care are crucial to prevent infection.

      Background

      Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated.

      Methods

      A total of 137 patients’ PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified.

      Results

      Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture.

      Conclusions

      The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.

      Key Words

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