Unfortunately, it’s not going to be oral therapy: RELEASE: Ethanol treatment may be instrumental in fighting IV-based infections.
MADISON – Inserted through the skin and into a vein, long-term intravascular devices such as IV catheters deliver to patients a range of life-saving medications, nutrition and fluids, among other uses.
But these life-saving devices also can provide a furtive pipeline for germs from the external world to gain access to the bloodstream of patients who often already are sick, resulting in a serious infection or even death, says professor of medicine Dr. Dennis G. Maki.
More than 200 million intravascular devices are in use in hospitals, clinics and outpatient settings today. Although health care staff who insert them wear sterile gloves and swab patient skin with disinfectant, about 500,000 patients each year develop an associated bloodstream infection. Of those, up to 30,000 die as a result of the infection, says Maki, who is head of the Medical School’s infectious diseases section.
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Maki’s new approach for patients with intravascular catheters is a daily "rinse cycle" with a 25- to 50-percent solution of ethyl alcohol, or medical-grade ethanol. "We fill each lumen of the catheter with the ethanol solution and then cap it off," says Maki.
"It is allowed to sit there for an hour, rapidly killing any germs that have insidiously gained access. We then simply pull it back out and reattach the IV fluids, intraveneous nutrition or intravenous medications, and the risk of later bloodstream infection caused by germs that may have gained access in the preceding 24 hours has been essentially eliminated."
So, no buzz (or very little, if it’s done right). The trick is to inject just enough to fill the catheter volume without over or under filling. You’d think that’s be easy, but it’s not: a lot of IV access devices are of ‘custom’ (nonstandard) lengths, and calculating their volume is nearly impossible clinically. For instance, dialysis catheters are supposed to have exactly this same process, but with heparin, a blood thinning agent. It’s not, unfortunately, unusual to have patients markedly anticoagulated when their catheters are overfilled.
It’s an intriguing idea, though. I hope it works, because medical grade ethanol is super cheap (most of the cost of booze is tax, and medical alcohol isn’t taxed).
It’s difficult to believe that this will be all that effective. The lumen of the catheter will be disinfected, but my impression has always been that bugs migrate from the skin down the outer surface of the catheter into the vein. I hope I’m wrong.
On the other hand, this is the kind of thing that could easily show that conventional wisdom about the pathogenesis of infections may need rethinking. This is a prophylactic process rather than trying to treat a local infection. It will be interesting to learn what a 50% ethanol solution does to tissues — there’s got to be some leakage.
This is cool, but this is cooler. Probably a lot more expensive, though. Eventually the costs will come down. And it might be like Lovenox, the initial cost is higher, but there wouldn’t be those administration costs.
I hope this works. I have lost 3 ESRD patients to sepsis in the last 4 months. It gets depressing, ya’ know. Actually, you could use medical grade ethanol to swab the skin and outside of the catheter too. Back in the days of the depression, when my grandparents couldn’t afford a doctor unless the situation was totally desperate, my grandmother used to swab sore throats with moonshine. It burned like heck, according to my mother, but it killed the germs.