Novel approach to investigate a source of microbial contamination of central venous catheters

Elliott, Tom; Moss, Helen; Tebbs, S. E.; Wilson, Ian C.; Bonser, Robert S.; Graham, Timothy R.; Burke, Louis; Faroqui, M.

doi:10.1007/bf01709583

Cited by 81 publications

(45 citation statements)

References 8 publications

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“…Biofilms have been shown by scanning electron microscopy and transmission electron microscopy to be universally present on CVCs and may be associated with either the outside of the catheter or the inner lumen (160). Organisms that colonize the CVC originate either from the skin insertion site, migrating along the external surface of the device, or from the hub, due to manipulation by health care workers, migrating along the inner lumen (62,162). Because the device is in direct contact with the bloodstream, the surface becomes coated with platelets, plasma, and tissue proteins such as albumin, fibrinogen, fibronectin, and laminin (162).…”

Section: Central Venous Cathetersmentioning

confidence: 99%

“…Raad et al (160) also showed that catheters in place for less than 10 days tended to have more extensive biofilm formation on the external surface of the catheter; for longer-term catheters (up to 30 days), biofilms were more extensive on the internal lumen. Organisms colonizing CVCs include CoNS, S. aureus, P. aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis, and Candida albicans (62,162).…”

Section: Central Venous Cathetersmentioning

confidence: 99%

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Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms

2002

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Though biofilms were first described by Antonie van Leeuwenhoek, the theory describing the biofilm process was not developed until 1978. We now understand that biofilms are universal, occurring in aquatic and industrial water systems as well as a large number of environments and medical devices relevant for public health. Using tools such as the scanning electron microscope and, more recently, the confocal laser scanning microscope, biofilm researchers now understand that biofilms are not unstructured, homogeneous deposits of cells and accumulated slime, but complex communities of surface-associated cells enclosed in a polymer matrix containing open water channels. Further studies have shown that the biofilm phenotype can be described in terms of the genes expressed by biofilm-associated cells. Microorganisms growing in a biofilm are highly resistant to antimicrobial agents by one or more mechanisms. Biofilm-associated microorganisms have been shown to be associated with several human diseases, such as native valve endocarditis and cystic fibrosis, and to colonize a wide variety of medical devices. Though epidemiologic evidence points to biofilms as a source of several infectious diseases, the exact mechanisms by which biofilm-associated microorganisms elicit disease are poorly understood. Detachment of cells or cell aggregates, production of endotoxin, increased resistance to the host immune system, and provision of a niche for the generation of resistant organisms are all biofilm processes which could initiate the disease process. Effective strategies to prevent or control biofilms on medical devices must take into consideration the unique and tenacious nature of biofilms. Current intervention strategies are designed to prevent initial device colonization, minimize microbial cell attachment to the device, penetrate the biofilm matrix and kill the associated cells, or remove the device from the patient. In the future, treatments may be based on inhibition of genes involved in cell attachment and biofilm formation

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Section: Central Venous Cathetersmentioning

confidence: 99%

Section: Central Venous Cathetersmentioning

confidence: 99%

Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms

2002

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“…Evidence that biofilms can develop on intravascular devices, including central venous catheters (CVCs), has been well documented (7,16). Colonization of the outer lumen of the catheter by microorganisms is usually the result of the catheter's proximity to skin flora.…”

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confidence: 99%

Biofilm Formation by Gram-Negative Bacteria on Central Venous Catheter Connectors: Effect of Conditioning Films in a Laboratory Model

2001

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Human blood components have been shown to enhance biofilm formation by gram-positive bacteria. We investigated the effect of human blood on biofilm formation on the inner lumen of needleless central venous catheter connectors by several gram-negative bacteria, specifically Enterobacter cloacae, Pseudomonas aeruginosa, and Pantoea agglomerans. Results suggest that a conditioning film of blood components promotes biofilm formation by these organisms in an in vitro system.

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“…access lines (6,7) and needleless connectors (NCs) (3,4) have been demonstrated to be a risk factor for blood stream infection (BSI). Patients who require long-term i.v.…”

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confidence: 99%

Protocol for Detection of Biofilms on Needleless Connectors Attached to Central Venous Catheters

et al. 2001

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Central venous catheter needleless connectors (NCs) have been shown to develop microbial contamination.A protocol was developed for the collection, processing, and examination of NCs to detect and measure biofilms on these devices. Sixty-three percent of 24 NCs collected from a bone marrow transplant center contained biofilms comprised primarily of coagulase-negative staphylococci.Intravenous (i.v.) access lines (6, 7) and needleless connectors (NCs) (3, 4) have been demonstrated to be a risk factor for blood stream infection (BSI). Patients who require long-term i.v. access, such as bone marrow transplant patients, are at even greater risk for BSI. To deliver i.v. fluids (e.g., medication, blood products, or nutrients), tubing must be connected to i.v. catheters that enter the patient's bloodstream. Until recently, such connections have been made using beveled, hollow-bore needles that pierce an elastic membrane on a catheter end cap. Because of the potential for needle-stick injuries and health care worker exposure to bloodborne pathogens, many institutions have recently adopted the use of NCs. Though safer for health care workers, the potential for NCs to increase BSI risk to patients has been documented in outbreaks of nosocomial BSI (3,4). In October 1998, the Centers for Disease Control and Prevention (CDC) was asked to investigate a BSI outbreak at a bone marrow transplant center in which NCs were involved. As part of this investigation, CDC assessed the ability of NCs to harbor biofilms that could act as a reservoir for BSI pathogens. It is well established that biofilms may develop on intravascular devices, including central venous catheters (CVCs) (1,2,8). Though contamination of NCs by various organisms has been observed (3, 4), the occurrence of biofilms on these devices has, to our knowledge, not been documented. The objectives of this study were (i) to develop a standardized protocol that could be used to collect, ship, and process NCs for biofilm contamination and (ii) to determine whether biofilms could develop on these devices and what organisms were the primary colonizers. Hickman NCs were collected from patients with long-term CVCs in a single bone marrow transplant center in which an outbreak of BSIs had occurred.Collection and shipment of NCs. Female-female luer couplings (no. 06359-42; Cole Parmer, Niles, Ill.) were autoclaved and then used to connect two 5-ml syringes. One of the syringes contained 5-ml of phosphate-buffered saline (PBS; pH 7.2; Life Technologies, Grand Island, N.Y.). Syringe pairs were placed into zip-lock bags and shipped on ice packs to the bone marrow transplant center for the collection of NCs. By using an aseptic technique, the NCs were removed from the patient's CVC and placed into an unused sterile Petri dish and transported to the laboratory. After the two syringes were separated, the luer coupling remained on one syringe. The smaller end of the NC was then wiped with a sterile alcohol pledget and connected to the syringe without the luer coupling. The other end o...

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Novel approach to investigate a source of microbial contamination of central venous catheters

Cited by 81 publications

References 8 publications

Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms

Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms

Biofilm Formation by Gram-Negative Bacteria on Central Venous Catheter Connectors: Effect of Conditioning Films in a Laboratory Model

Protocol for Detection of Biofilms on Needleless Connectors Attached to Central Venous Catheters

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