Compliance With Central Venous Catheter Dressings- How are We Doing?

We are well aware of central line insertion checklists for the placement of central venous catheters (CVC). Following CVC insertion, proper maintenance is important to minimize the risk of a CVC associated bloodstream infection. How well do we abide by evidence based catheter maintenance standards? Per an article published in the American Journal of Infection Control, there is room for improvement.

The study evaluated a total of 420 CVC sites and found deficiencies in 31%. Internal jugular CVC dressings were the most frequently deficient type (P = 0.001). No correlation between CVC site maintenance and central line–associated bloodstream infections was detected (Spearman's correlation coefficient = 0.007; P = 0.98).

The most common suboptimal CVC dressing conditions were blood under the dressing, marked dressing edge lift or exposed catheter and visible moisture under the dressing.

We should not be surprised that compliance with catheter site maintenance is less than optimal. As with nearly all components of infection prevention and safety, implementation of practice change is a challenge. 

Why should something as simple as appropriately dressing a central venous catheter be any different?