Review of Central Venous Catheter-Related Infections and UV-C as a Potential Solution
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Published:
Feb 20, 2017
Keywords:
sterilization, central venous catheters (CVC), ultraviolet light (UV), infections, catheter related bloodstream infection (CRBSI), hospital-acquired infection (HAI), bacteremia, sepsis, intensive care unit (ICU), hemodialysis, chemotherapy
Main Article Content
Abstract
Central venous catheters (CVCs) are indispensable medical devices that are utilized in clinical settings globally. Though CVCs provide life-saving functions, they are highly susceptible to bacterial colonization that eventually leads to catheter-related bloodstream infection (CRBSI). Existing strategies in hospitals such as standard sterilization protocols have not been effective in significantly lowering the rate of CRBSIs in the past decade. The use of ultraviolet (UV) light as a source of microbial disinfectant is historically known. In particular, UV-C light has been shown to effectively eradicate bacteria, including strains that are difficult to kill with antibiotics. Many studies show that multiple logs-reduction in bacterial colonization after UV-C exposure can be achieved. With the emergence of light emitting diodes (LEDs) that deliver UV-C, the idea of applying UV-C energy to sterilize catheters has become more practical to implement due to their small size and low power consumption implement. In addition to its efficacy against bacteria, UV-C has also been shown to have little to no negative health effect on human tissues and minimal photochemical effect on infusates commonly delivered through CVCs. Central venous catheters (CVCs) are indispensable medical devices that are utilized in clinical settings globally. Though CVCs provide life-saving functions, they are highly susceptible to bacterial colonization that eventually leads to catheter-related bloodstream infection (CRBSI). Existing strategies in hospitals such as standard sterilization protocols have not been effective in significantly lowering the rate of CRBSIs in the past decade. The use of ultraviolet (UV) light as a source of microbial disinfectant is historically known. In particular, UV-C light has been shown to effectively eradicate bacteria, including strains that are difficult to kill with antibiotics. Many studies show that multiple logs-reduction in bacterial colonization after UV-C exposure can be achieved. With the emergence of light emitting diodes (LEDs) that deliver UV-C, the idea of applying UV-C energy to sterilize catheters has become more practical to implement due to their small size and low power consumption implement. In addition to its efficacy against bacteria, UV-C has also been shown to have little to no negative health effect on human tissues and minimal photochemical effect on infusates commonly delivered through CVCs. Altogether, UV-C light has a promising application in the prevention of CRBSIs that is not only effective but safe., UV-C light has a promising application in the prevention of CRBSIs that is not only effective but safe.
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1.
Burapachaisri A, Sophonpanich C, Raja A, Pan C, Sundravorakul P, Bandasak R. Review of Central Venous Catheter-Related Infections and UV-C as a Potential Solution. BKK Med J [Internet]. 2017 Feb. 20 [cited 2024 Dec. 22];13(1):99. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/221812
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This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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7. Yevslin AS, Arif A, Loay S. Interventional Nephrology:Principles and Practice. 2014.
8. Mermel LA. What Is The Predominant Source of Intravascular Catheter Infections? Clin Infect Dis 2011;52(2):211–2.
9. Mathur P. Hand hygiene: Back to the basics of infection control. Indian J Med Res 2011;134(5):611-20.
10. Dancer S. Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination. Clin Microbiol Rev 2014;27(4):665-90.
11. Chopra V, Olmsted R, Safdar N, et al. Prevention of Central Line-Associated Bloodstream Infections: Brief Update Review. In: Krein S, editor. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville; 2013.
12. Shapey I, Foster M, Whitehouse T, et al. Central venous catheter-related bloodstream infections: improving postinsertion catheter care. J Hosp Infect 2009;71(2):117-22.
13. Pronovost D, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU.N Engl J Med 2006; 355(26): 2725-32.
14. Gahlot R, Nigam C, Kumar V, et al. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci 2014; 4(2):162-7.
15. Mah TF, O’Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol 2001;9(1):34-9.
16. Wilkins KM, Hanlon GW, Martin GP, et al. The migration of bacteria through gels in the presence of IUCD monofilament tails. Contraception1989;39(2):205-16.
17. Wolfe AJ, Berg HC. Migration of bacteria in semisolid agar. Proc Natl Acad Sci U S A 1989;86(18):6973-7.
18. Harkes G, Dankert J, Feijen J. Bacterial migration along solid surfaces. Appl Environ Microbiol1992;58(5):1500-5
19. Garrett, TR, et al. Bacterial adhesion and biofilms on surfaces. Progress in Natural Science 2008;18(9):1049-56.
20. Sudarsan, R, Ghosh S, Stockie JM, et al. Simulating biofilm deformation and detachment with the immersed boundary method. Communications in Computational Physics 2016;19(3):682-732.
21. Shunmugaperumal, T. Biofilm Eradication and Prevention: A Pharmaceutical Approach to Medical Device Infections; 2010:78.
22. Mascari L, Ymele-Leki P, Eggleton C, et al. Fluid Shear Contribution to Bacteria Cell Detachment Initiated by a Monoclonal Antibody. Wiley Periodicals. 2003.
23. Lecuyer S, Rusconi R, Shen Y, et al. Shear stress increases the residence time of adhesion of Pseudomonas eruginosa.Biophys J 2011;100(2):341-50.
24. Stewart PS. Biophysics of biofilm infection. Pathog Dis 2014;70(3):212-8
25. Doran AK, Ivy DD, Barst RJ, et al. Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension. Int J Clin Pract Suppl 2008;62:5-9.
26. Drewett SR. Central venous catheter removal: procedures and rationale. Br J Nurs 2000;9(22):2304-15.
27. Kim DK, Gottesman MH, Forero A, et al. The CVC removal distress syndrome: an unappreciated complication of central venous catheter removal. Am Surg 1998;64(4):344-7.
28. Chaftari A-M, Zakhem AE, Jamal MA, et al. The use of minocycline-rifampin coated central venous catheters for exchange of catheters in the setting of staphylococcus aureus central line associated bloodstream infections. BMC Infect Dis 2014;14:518.
29. Doran AK, Ivy DD, Barst RJ, et al. Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension. Int J Clin Pract Suppl 2008;62:5-9.
30. Jacob J. Pathophysiology of Sepsis. Am J Heal Pharm 2002;136:1-51.
31. Klingenberg C, Aarag E, Rønnestad A, et al. Coagulasenegative staphylococci sepsis in neonates. Association between antibiotic resistance, biofilm formation, and the host inflammatory response. Pediatr Infect Dis J 2005; 24(9):817-822.
32. Furuya YE, Dick A, Perencevich EN, et al. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011;6(1):e15452.
33. Pradeep Kumar SS, Easwer HV, Maya Nandkumar A.Multiple drug resistant bacterial biofilms on implanted catheters - a reservoir of infection. J Assoc Physicians India 2013;61(10):702-7.
34. Menyhay S, Maki D. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 2006;27(1):23-7.
35. Rabindranath KS, Bansal T, Adams J, et al. Systematic review of antimicrobials for the prevention of haemodialysis catheterrelated infections. Nephrol Dial Transplant 2009;24(12):3763-74.
36. Theaker, C, Juste R, Lucas N, et al. Comparison of bacterial colonization rates of antiseptic impregnated and pure polymer central venous catheters in the critically ill. J Hosp Infect 2002;52(4);310-2.
37. Sánchez-Prado L, Llompart M, Lores M, et al. Further research on the photo-SPME of triclosan. Anal Bioanal Chem 2006;384(7-8):1548-57.
38. Hoiby N, Bjarnsholt, T, Givskov M, et al. Antibiotic resistance of bacterial biofilms. Int J Antimicrob Agents 2010;35:322-32.
39. Crnich CL, Maki DG. Are Antimicrobial-impregnated catheters effective? Don’t throw out the baby with the bathwater. Clin Infect Dis 2004;38(9):1287-92.
40. Skovgaard S, Nielsen L, Larsen M, et al. Staphylococcus epidermidis isolated in 1965 are more susceptible to triclosan than current isolates. PLoS One 2013;8(4):e62197.
41. Brunelli SM, Njord L, Hunt AE, et al. Use of the Tego needlefree connector is associated with reduced incidence of catheter-related bloodstream infections in hemodialysis patients. Int J Nephrol Renovasc Dis 2014;7:131-9.
42. Cookson ST, Ihrig M, O’Mara EM. Increased bloodstream infection rates in surgical patients associated with recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol 1998;19:23-7.
43. Soi V, Moore CL, Kumbar L, et al. Prevention of catheterrelated bloodstream infections in patients on hemodialysis: challenges and management strategies. Int J Nephrol Renovasc Dis 2016; 9:95-103.
44. Luther MK, Bilida S, Mermel LA, et al. Ethanol and Isopropyl Alcohol Exposure Increases Biofilm Production in Staphylococcus aureus and Staphylococcus epidermidis. Infect Dis Ther 2015;4(2):219-26.
45. WrightMC, Tropp J, Schora DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41(1):33-8.
46. Landry DL, Braden GL, Gobeille SL, et al. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol 2010;5(10):1799-804.
47. Solomon LR, Cheesbrough JS, Bhargava R, et al. Observational study of need for thrombolytic therapy and incidence of acteremia using taurolidine-citrate-heparin, taurolidinecitrate and heparin catheter locks in patients treated with hemodialysis. Semin Dial 25(2):233-8.
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