Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-26T18:51:19.776Z Has data issue: false hasContentIssue false
  • English
  • Français

Nonuniform Risk of Bloodstream Infection with Increasing Central Venous Catheter-Days

Published online by Cambridge University Press:  21 June 2016

Mary-Louise McLaws  and
Geoffrey Berry
Mary-Louise McLaws*
Affiliation:
NSW Hospital Infection Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
Geoffrey Berry
Affiliation:
School of Public Health, University of Sydney, New South Wales, Australia
*
2nd Floor Samuels Building, NSW Hospital Infection Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine whether the conventional rate for central venous catheter (CVC)-associated bloodstream infection (BSI) accurately reflects risk for patients exposed for a variety of in situ periods.

Patients and Methods:

Intensive care unit patients (n = 1,375) were monitored for 7,467 CVC-days. They were monitored until catheter removal, until diagnosis of CVC-associated BSI, or for 24 hours after discharge.

Results:

The BSI rate was 3.7 per 1,000 CVC-days. Ninety-three percent of these patients had CVCs in situ for 1-15 days. These patients were exposed to 59.7% of all CVC-days; the remaining 7% were exposed to 40.3% of all CVC-days. BSI rates stratified by exposure periods of 1-5 and 6-15 days were 2.1 and 4.5 per 1,000 CVC-days, respectively. The rates for 16-30 and 31-320 days were 10.2 and 2.1 per 1,000 CVC-days, respectively. The probability of BSI with a CVC in situ was 6 in 100 by day 15, 14 in 100 by day 25, 21 in 100 by day 30, and 53 in 100 by day 320.

Conclusion:

The conventional aggregated rate better reflects the risk for the majority of patients rather than for patients exposed to the majority of CVC-days. It does not reflect the true probability of risk for all exposures, especially beyond 30 days. CVCs in situ from 1 to 15 days had less risk of BSI than CVCs in situ more than 15 days, which may explain why scheduled CVC replacement at days 5 to 7 has not been found beneficial.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 8 , August 2005 , pp. 715 - 719
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.Google Scholar
2.McLaws, M-L, Taylor, P. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. J Hosp Infect 2003;53:260–268.Google Scholar
3.Armitage, P, Berry, G, Matthews, JNS. Statistical Methods in Medical Research, ed. 4. Oxford: Blackwell; 2002.CrossRefGoogle Scholar
4.Centers for Disease Control and Prevention. Guidelines for prevention of intravascular catheter-related infections. MMWR 2002;51 (RR-10): 129.Google Scholar
5.Department of Health and Ageing. Infection Control Guidelines for the Prevention of Transmission of Infectious Diseases in the Health Care Setting, draft 22, version 3. Commonwealth of Australia: Department of Health and Ageing; 2002. Available at www.health.gov.au/pubhlth/strateg/communic/review/drafthtm.Google Scholar
6.Polderman, KH, Girbes, ARJ. Central venous catheter use: Part I. Mechanical complications. Intensive Care Med 2002;28:1–17.CrossRefGoogle ScholarPubMed
7.Polderman, KH, Girbes, ARJ. Central venous catheter use: Part 2. Infectious complications. Intensive Care Med 2002;28:18–28.Google Scholar
8.Pearson, ML. Guideline for prevention of intravascular device-related infections: an overview. Am J Infect Control 1996;24:262–293.Google Scholar
9.Crump, JA, Collignon, PJ. Intravascular catheter-associated infections. Eur J Clin Microbiol Infect Dis 2000;19:1–8.Google Scholar
10.Collignon, P. Intravascular catheter associated sepsis: a common problem. Med J Aust 1994;161:374–378.Google Scholar
11.Merrer, J, De Jonghe, B, Golliot, F, et al.Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700–707.Google Scholar
12.Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized controlled trial. Ann Intern Med 1997;127:257–266.Google Scholar
13.McKinley, S, Mackenzie, A, Finfer, S, Ward, R, Penfold, J. Incidence and predictors of central venous catheter related infection in intensive care patients. Anaesth Intensive Care 1999;27:164–169.Google Scholar
14.Pratt, JW. Length of confidence intervals. Journal of the American Statistical Association 1961;56:549–567.Google Scholar
15.Gart, JJ, Nam, J. Approximate interval estimation of the ratio of binomial parameters: a review and corrections for skewness. Biometrics 1988;44:323–338.CrossRefGoogle ScholarPubMed
16.Huggonnet, S, Sax, H, Eggimann, P, Chevrolet, JC, Pittet, D. Nosocomial bloodstream infection and clinical sepsis. Emerg Infect Dis 2004;10:76–81.CrossRefGoogle Scholar
17.Öncu, S, Özsut, H, Yildirim, A, Ay, P, Çakar, N, Eraksoy, H, Çalangu, S.Central venous catheter related infections: risk factors and the effect of glycopeptide antibiotics. Annals of Clinical Microbiology and Antimicrobials 2003;2:3–8.Google Scholar
18.Frankel, DJ, Packard, C, Lipman, J. Can we achieve consensus on central venous catheter-related infections? Anaesth Intensive Care 2000;28:475–490.Google Scholar
19.Reed, CR, Sessler, CN, Glauser, FL, Phelan, BA. Central venous catheter infections: concepts and controversies. Intensive Care Med 1995;23:310–316.Google Scholar
20.McGee, DC, Gould, MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123–1133.CrossRefGoogle ScholarPubMed
21.Cook, D, Randolph, A, Kernerman, P, et al.Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 1997;25:1417–1424.Google Scholar
22.Bonawitz, SC, Hammell, EJ, Kirkpatrick, JR. Prevention of central venous catheter sepsis: a prospective randomized trail. Am Surg 1991;57:618–623.Google Scholar
23.Cobb, DK, High, KP, Sawyer, RG, et al.A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062–1068.Google Scholar
24.Collins, GR. Decreasing catheter colonization through use of an antiseptic-impregnated catheter: a continuous quality improvement project. Chest 1999;115:1632–1640.Google Scholar
25.Rickard, CM, Lipman, J, Courtney, M, Siversen, R, Daley, P. Routine changing of intravenous administration sets does not reduce colonization or infection in central venous catheters. Infect Control Hosp Epidemiol 2004;25:650–655.Google Scholar
26.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759–769.Google Scholar
27.Morton, A, Whitby, M, McLaws, M-L, et al.The application of process control chart methodology to the detection and monitoring of hospital-acquired infections. Biometrics 2001;21:112–117.Google Scholar