Device‐Related Infections

It has been estimated that at least a third of device-related infections, particularly those related to intravascular catheters, are preventable. Basic practices of infection control that may help to achieve this goal include avoiding unnecessary catheter insertions, using maximum barrier precautions and chlorhexidine skin preparation for insertion of central vascular catheters, optimizing care of catheters while they are in use, and promptly removing catheters that are not in use or are no longer needed. The selection of the most appropriate catheter, especially the role for antimicrobial- or antiseptic-coated devices, remains a debated topic. The following article is the first in a series of 3 reviews based on presentations made at the 38th Annual Meeting of the Infectious Diseases Society of America (September 7–10, 2000) in Symposium 100, “Device-Associated Infections: New Insights into Pathogenesis and Prevention.” These 3 reviews explore the biologic events on device surfaces, the impact of these events on infection control practices, and the practical aspects of prevention of vascular catheter–related infections. The first article is “Biofilm Formation: A Clinically Relevant Microbiologic Process,” by Dr. Rodney M. Donlan, in which he reviews our increased understanding of the complex microcosm of biofilms. The second and third reviews in the series will appear in future issues of CID. The second, “Device-Associated Infections: A Macroproblem That Starts with Microadherence,” by Dr. Rabih O. Darouiche, delves further into the multifaceted interactions among bacteria, indwelling devices, and the host response to foreign bodies. The third review, “Preventing Vascular Catheter–Related Infections: Current Controversies,” by Dr. Barry M. Farr, places recent advances in catheter care and design in perspective and addresses the practical question of how our understanding of device-related infections can be translated into effective strategies to prevent bloodstream infections.