Prevention of catheter sepsis: The hub

The prevention of catheter sepsis lies in a sound understanding of the routes through which catheters get contaminated. The catheter hub has been recognized as a portal for microorganisms causing catheter sepsis, particularly in central venous catheters inserted for >1 wk. Bacteria and fungi may reach the internal surface of the catheter connector during manipulation by hospital staff and then colonize the entire lumen of the catheter. Endoluminal contamination has diagnostic, therapeutic, and preventive implications. Some traditional preventive approaches (site care, subcutaneous cuffs and tunnels, maximal aseptic barriers at the time of catheter insertion, and external antiseptic of antibiotic coating) may fail because they focus solely on the skin as a source of bacteria. Hub-related catheter sepsis can be prevented by aseptic hub manipulation, appropriate junction protection, and by reducing the number of catheter lumens, side ports, three-way stopcocks, and changes of the infusion sets. Needleless systems must be evaluated in terms of their safety in preventing endoluminal contamination. A new disinfecting catheter hub incorporating an antiseptic barrier has been developed and reduced hub-related catheter sepsis by more than 90%. The endoluminal route of intravascular catheter contamination must be taken into account when designing strategies for the diagnosis and prevention of catheter-related sepsis. (C) Elsevier Science Inc. 1997.