[Table of Contents]

Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Preventing Infections Associated with Indwelling Intravascular Access Devices

APPENDIX II

Definitions of Intravascular Device-Associated Infections

The following descriptions are provided for information only, representing previous definitions that have been reported in the literature. They are not recommended for use in surveillance.

Exit- or insertion-site infection is usually defined as purulence around the catheter entry site in the absence of bloodstream infection. Erythema, warmth, tenderness and swelling is suggestive of cellulitis, but inflammation may be due to other causes. Quantitative skin cultures may be diagnostic.

Tunnel infection has been described as a spreading cellulitis around the subcutaneous tunnel tract (Table 1).

Local catheter-related infection is a confusing term because it has been defined by some as growth of >= 15 colony-forming units (CFU) on semiquantitative culture of an intravascular catheter tip. Some call this catheter colonization (see Section Cin the Introduction) to distinguish it from contamination and clinically apparent infection. Others have used the terms "catheter contamination" or "catheter colonization" to refer to a catheter tip with < 15 CFU on semiquantitative culture.

Primary bloodstream infection has been described as a positive blood culture and clinical manifestations of sepsis with no other apparent source (e.g., pneumonia, wound or urinary tract infection). Primary bloodstream infection can be divided into the following two categories:

1. probable catheter-related septicemia: common skin organism isolated from one or more blood cultures in a patient with clinical manifestation of sepsis and no apparent source for the sepsis except the catheter

2. definite catheter-related sepsis: septicemia caused by any organism for which one of the following is true:

• the same organism is isolated from blood and from pus at the insertion site, tunnel, or pocket;

• there is clinical sepsis that is refractory to antimicrobial therapy (see Appendix III) or is not treated but resolves after catheter removal;

• quantitative catheter culture is positive with isolation of the same organism from the catheter and bloodstream; or

quantitative blood cultures show a 10-fold higher colony count from blood drawn through a central catheter than blood simultaneously drawn from a peripheral vein.

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