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. 2019 Jan;20(1):51-59.
doi: 10.1177/1757177418805836. Epub 2018 Nov 9.

Evaluation of Skin Colonisation And Placement of vascular access device Exit sites (ESCAPE Study)

Nancy L Moureau  1 , Nicole Marsh  2 , Li Zhang  3 , Michelle J Bauer  3 , Emily Larsen  3 , Gabor Mihala  4 , Amanda Corley  3   5 , India Lye  3   5 , Marie Cooke  3 , Claire M Rickard  3   6
Affiliations

Evaluation of Skin Colonisation And Placement of vascular access device Exit sites (ESCAPE Study)

Nancy L Moureau et al. J Infect Prev. 2019 Jan.

Abstract

Background: Skin microorganisms may contribute to the development of vascular access device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is little evidence to inform choice of VAD site selection.

Objective: To compare microorganisms present at different body sites used for VAD insertions and understand the effect of transparent dressings on skin microflora.

Methods: The ESCAPE observational study consisted of three phases: (1) skin swabs of four sites (mid-neck, base neck, chest, upper arm) from 48 hospital patients; (2) skin swabs of five body sites (mid-neck, base neck, chest, upper arm, lower arm) from 10 healthy volunteers; and (3) paired skin swabs (n = 72) under and outside of transparent dressings from 36 hospital patients (16 mid/base neck, 10 chest, upper arm). Specimens were cultured for 72 h, species identified and colony-forming units (CFU) counted. Ordinal logistic regression compared CFU categories between variables of interest.

Results: The chest and upper arm were significantly associated with fewer microorganisms compared to neck or forearm (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.25-0.65, P < 0.05). CFU levels under transparent dressings were not significantly different from outside (OR = 0.57, 95% CI = 0.22-1.45). Staphylococci were predominant at all sites. Other significant (P < 0.05) predictors of higher CFU count included prolonged hospitalisation and medical/surgical patient status.

Discussion: Skin microorganism load was significantly lower at the upper arm or chest, compared to the mid- or base neck. This may impact VAD site selection and subsequent infection risk.

Keywords: Infection; central venous; colonisation; intravenous catheter; risk; site selection; skin microorganisms; vascular access device.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Griffith University, Brisbane, Queensland, Australia received unrestricted research and educational grants from 3M, Cook and Entrotech for this study. Although funding was received no commercial entity had any role in the conception, design, performance of research or preparation of the manuscript. NLM, the chief executive officer of PICC Excellence, Inc, Hartwell, GA, USA, provided online educational access to AngioDynamics, Teleflex, Medcomp and Cook Medical; vascular access nurse employee at Greenville Memorial and University Medical Center, Greenville, SC; serves as a speaker for 3M, Access Scientific, Entrotech, Nexus Medical, Teleflex; and educational consultant for B. Braun, Chiesi, Linear Health Sciences, Nexus Medical, Parker Laboratories and Signostics Medical. NM’s employer has received on her behalf: consultancy payments for educational lectures based on her research from Hospira and Becton Dickinson (BD), and unrestricted research grants from Adhezion and BD. LZ’s employer has received on her behalf: an unrestricted research grant from BD. EL’s employer has received on her behalf: a consultancy payment for an educational lecture from 3M. MC’s employer has received on her behalf: unrestricted research and educational grants from: 3M, Adhezion, Angiodynamics, Bard, Baxter, BBraun, BD, Carefusion, Centurion Medical Products, Cook Medical, Entrotech, Flomedical, ICU Medical, Medical Australia, Medtronic, Smiths Medical, Teleflex; consultancies payments for educational lectures from BD. CMR’s employer has received on her behalf: unrestricted research and educational grants from: 3M, Adhezion, Angiodynamics, Bard, Baxter, BBraun, BD, Carefusion, Centurion Medical Products, Cook Medical, Entrotech, Flomedical, ICU Medical, Medical Australia, Medtronic, Smiths Medical, Teleflex; consultancies payments for educational lectures from 3M, Bard, BBraun, BD,Carefusion and Mayo, and expert reports from BD, ResQDevices and Smiths Medical.

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