Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.

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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill.

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Niccolò Buetti MD, MSc, PhD12a , Jonas Marschall MD, MSc34a , Marci Drees MD, MS56 , Mohamad G. Fakih MD, MPH7 , Lynn Hadaway MEd, RN, NPD-BC, CRNI8, Lisa L. Maragakis MD, MPH9, Elizabeth Monsees PhD, MBA, RN, CIC1011 , Shannon Novosad MD MPH12, Naomi P. O’Grady MD13, Mark E. Rupp MD14 , Joshua Wolf MBBS, PhD, FRACP1516 , Deborah Yokoe MD, MPH17 and Leonard A. Mermel DO, ScM1819 1Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland, 2University of Paris, Paris, France, 3Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland, 4Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States, 5ChristianaCare, Wilmington, Delaware, United States, 6Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States, 7Ascension Healthcare and Wayne State University School of Medicine, Detroit, Michigan, United States, 8Lynn Hadaway Associates, Milner, Georgia, United States, 9Johns Hopkins University School of Medicine, Baltimore, Maryland, United States, 10Children’s Mercy Hospital, Kansas City, Missouri, United States, 11University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States,, 12Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States, 13National Institutes of Health, Bethesda, Maryland, United States, 14University of Nebraska Medical Center, Omaha, Nebraska, United States, 15Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States, 16Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States, 17University of California–San Francisco, San Francisco, California, United States, 18Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States and 19Rhode Island Hospital, Providence, Rhode Island, United States

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Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update

On 5 May 2017, the European Centre for Disease Prevention and Control (ECDC) published its updated protocol for surveillance of healthcare-associated infections (HAIs) and prevention indicators in European intensive care units (ICUs) [1]. The ECDC’s Healthcare-Associated Infections surveillance Network (HAI-Net) has been coordinating European surveillance of HAIs in ICUs since 2008 with participation of 15 countries and 1365 ICUs in 2015 [2]. The methodology was originally developed by the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) project in 2000–2002 [3] and adopted by ECDC in 2010. A revision of the first protocol was agreed at consensus expert meetings in 2013–2015. The objective of the ECDC surveillance protocol is the standardisation of case definitions, data collection and reporting procedures for hospitals participating in national or regional surveillance of HAIs in ICUs across Europe in order to facilitate the collection of comparable epidemiological data as a basis for interventions and the communication and exchange of experience of national surveillance systems. The case definitions of HAIs aim to accommodate differences, across Europe, in diagnostic practices such as taking microbiological samples for the diagnosis of HAIs. The minimal requirement for participation in surveillance of HAIs in ICUs is surveillance of bloodstream infections (BSIs) and pneumonia (PN). Reporting of urinary tract infections (UTIs) and catheter-related infections (CRIs) is optional. The data are collected by the national surveillance systems and submitted annually to ECDC. The results are published on the ECDC website [2]. A software application, HelicsWin. Net, is available free-of-charge for entry of HAI surveillance data (https ://ecdc.europ a.eu/en/publi catio ns-data/ helic swinn et-hwn). The latest update of the ECDC protocol was triggered by the unexplained, large variation in the prevalence of HAIs among European countries reported by the ECDC point prevalence survey of HAIs and antimicrobial use in European acute care hospitals 2011–2012. Structure and process indicators for infection prevention and control and antimicrobial stewardship (Table 1), as well as a new variable on the outcome of the HAI were included in the latest version of the surveillance protocol. These modifications were developed by ECDC and HAI-Net ICU experts and agreed during an HAI-Net ICU meeting in February 2015. The ECDC case definitions applied for surveillance of HAIs in European ICUs are presented in Table 1a in the supplementary material. The case definition for BSI addresses both primary and secondary BSIs. A definition for CRI establishes the microbiological criteria for assignment of the catheter as the origin of the BSI. When CRIs are not specifically reported, BSIs for which the same microorganism was cultured from the catheter or when symptoms improved within 48 h after removal of the catheter are reported as BSIs with origin central venous catheter (CVC). In this way, it is possible to assess the burden of BSIs linked to catheters in ICUs with different local practices for microbiological confirmation through culture of the catheter *Correspondence: diamantis.plachouras@ecdc.europa.eu 1 European Centre for Disease Prevention and Control, Gustav III:s boulevard 40, 169 73 Solna, Sweden Full author information is available at the end of the article

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ECDC definitions and methods for the surveillance of healthcare-associated infections in intensive care units.

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Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies

To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators. Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance. Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions. This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.

Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections.

The incidence of anal dysplasia caused by the human papilloma virus (HPV) is increasing in men and can be a precursor to the development of anal cancer (1). Oncogenic HPV types are believed to be the causative agent in up to 90% of anal cancers. In men who have sex with men (MSM) living with the Human Immunodeficiency Virus (HIV), the incidence of anal cancer is even higher (45.9 per 100,000) vs. (5.1 per 100,000) in MSM not living with HIV (2). Additionally studies have shown that the prevalence of having any type of anal HPV type can be as high as 92.6% in MSM living with HIV (3). There are well known screening guidelines for cervical cancer in women starting at age 21. However, screening for anal dysplasia caused by HPV in high risk adolescent/young adult (AYA) population (<26 years old) such as MSM living with HIV is not standardized or universally recommended even though the risk of anal cancer in this population can be as high as two times the rate of cervical cancer in women (4). Anal cytology has been recommended by several research groups for screening at-risk populations for anal cancer based on the guidelines of cervical screening; however, there are no universal screening guidelines for MSM living with HIV <35 years of age (5, 6). The purpose of this opinion paper is to review current recommendations for screening for anal dysplasia in AYAMSM living with HIV, with implications for clinical practice and research.

Screening for Anal Dysplasia in Adolescent and Young Adult Men Who Have Sex With Men Living With HIV, a Review of Current Recommendations

Purpose: The objectives of this study were to assess the knowledge of HIV and pre-exposure prophylaxis (PrEP) in transgender adolescents and young adults (AYAs) and to test the acceptability of rapid HIV testing among transgender adolescents in a multidisciplinary gender clinic. Methods: Participants enrolled on the same day as their mental health or medical appointment in a multidisciplinary gender clinic. They completed survey questions regarding HIV and PrEP knowledge and were also offered an optional same-day, rapid, fourth-generation HIV test. Participants who had an HIV test answered additional questions about their testing experience. Results: We enrolled 61 participants; just over half (n=31) were assigned female at birth. Less than a third (n=20, 32.8%) scored 80% or above regarding HIV knowledge. Nearly half of the participants (n=29, 47.5%) were not interested in PrEP. Forty-one percent of participants chose to have a rapid HIV test; all were “satisfied” with the testing experience. There were no positive HIV results. Conclusions: Transgender AYAs have gaps in their understanding of HIV acquisition and transmission. Rapid HIV testing in the setting of gender care is well received by those who desire testing and may be a way to increase knowledge of transgender AYA HIV status. 

HIV/Pre-Exposure Prophylaxis Knowledge and Acceptability of Rapid HIV Testing Among Transgender Adolescents in a Multidisciplinary Gender Clinic

Objective There are limited studies evaluating anal cytology results or the prevalence of anal human papiloma virus in adolescent and young adult (AYA) men who have sex with men (MSM). The purpose of this study was to review anal cytology screening results and determine whether abnormal findings resulted in completion of anoscopy in AYA MSM (13–26 years old). Patients and Methods This was a retrospective study evaluating 84 anal Papanicolaou screening results among 36 AYA MSM patients aged 13–26 years who had an anal Papanicolaou test completed at an outpatient Adolescent/Young Adult Medicine Practice at Boston Children's Hospital, an urban, nonprofit, academic, free-standing children's hospital, from January 1, 2010, to December 31, 2020. Results The findings of anal Papanicolaou screening included atypical squamous cells of undetermined significance (ASCUS) (37%), negative for squamous intraepithelial lesion (31%), inability to read (21.3%), and low-grade squamous intraepithelial lesion (10.8%). Most patients who had ASCUS results were referred for anoscopy (n = 28, 90.3%), and of those referred only 6.5% (n = 2) completed an anoscopy. Of those with low-grade squamous cell intraepithelial lesion results, 88.9% (n = 8) were referred for anoscopy, and among those who were referred, only 3.3% (n = 3) had completed an anoscopy. Conclusion This study showed that there were abnormalities in cytology when anal Papanicolaou test screening was performed in this population, and the completion rates for anoscopy were low.

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Susan FitzGerald

Papers

Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections.

Screening for Anal Dysplasia in Adolescent and Young Adult Men Who Have Sex With Men Living With HIV, a Review of Current Recommendations

HIV/Pre-Exposure Prophylaxis Knowledge and Acceptability of Rapid HIV Testing Among Transgender Adolescents in a Multidisciplinary Gender Clinic

Anal dysplasia in adolescent and young adult men who have sex with men: a single-center retrospective and descriptive study (2010–2020)