Prospective surveillance study for risk factors of central venous catheter–related bloodstream infections (original) (raw)
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Critical Care, 2005
Introduction Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. Although there are many studies about CVC-related infection, very few have analyzed it in detail. The objective of this study was to analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites. Methods This is a prospective and observational study, conducted in a 24-bed medical surgical intensive care unit of a 650-bed university hospital. All consecutive patients admitted to the ICU during 3 years (1 May 2000 and 30 April 2003) were included. Results The study included 2,018 patients. The number of CVCs and days of catheterization duration were: global, 2,595 and 18,999; subclavian, 917 and 8,239; jugular, 1,390 and 8,361; femoral, 288 and 2,399. CRLI incidence density was statistically higher for femoral than for jugular (15.83 versus 7.65, p < 0.001) and subclavian (15.83 versus 1.57, p < 0.001) accesses, and higher for jugular than for subclavian access (7.65 versus 1.57, p < 0.001). CRBSI incidence density was statistically higher for femoral than for jugular (8.34 versus 2.99, p = 0.002) and subclavian (8.34 versus 0.97, p < 0.001) accesses, and higher for jugular than for subclavian access (2.99 versus 0.97, p = 0.005). Conclusion Our results suggest that the order for punction, to minimize the CVC-related infection risk, should be subclavian (first order), jugular (second order) and femoral vein (third order).
CHEST Journal, 2005
Study objectives: To determine the risk of PICC-related BSI in hospitalized patients. Study design: Prospective cohort study using data from two randomized trials assessing the efficacy of chlorhexidine-impregnated sponge dressing and chlorhexidine for cutaneous antisepsis. Methods: PICCs inserted into the antecubital vein in two randomized trials during from 1998 to 2000 were prospectively studied; most patients were in an ICU. PICC-related BSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of removal and from blood cultures by restriction-fragment DNA subtyping. Results: Overall, 115 patients had 251 PICCs placed. Mean duration of catheterization was 11.3 days (total, 2,832 PICC-days); 42% of the patients were in an ICU at some time, 62% had urinary catheters, and 49% had received mechanical ventilation. Six PICC-related BSIs were identified (2.4%), four with coagulasenegative staphylococcus, one with Staphylococcus aureus, and one with Klebsiella pneumoniae, a rate of 2.1 per 1,000 catheter-days.
Clinical Microbiology and Infection, 2004
This study analysed 89 episodes of catheter-related bloodstream infection (CR-BSI) occurring during one week in 107 hospitals from 21 European countries (1.02 episodes ⁄ 1000 admissions). Patients from European Union (EU) countries had a higher incidence of CR-BSI than patients from non-EU countries (1.55 vs. 0.33 ⁄ 1000 admissions). Most (67%) catheters were non-tunneled central venous catheters, were in the jugular vein (44%), had been implanted for > 7 days (70%), were made of polyurethane (61%) and were multilumen (67%). In 36% of cases, catheters were implanted by physicians other than anaesthetists or surgeons, and 50% were inserted by junior staff.
2020
Central Venous Catheters (CVCs) are indispensable in current intensive care treatment; also pose a greater risk of device related infections in comparison to any other type of medical device and are major cause of morbidity, mortality and increased expense. A cross sectional prospective study of one year duration was conducted in the tertiary care University Hospital ICU located in the rural region of Haryana, India, to determine the incidence of the central venous catheter related bloodstream infection (CRBSI), rate of catheter colonization and to identify the associated risk factors and the microbial spectrum of CRBSI along with the antimicrobial sensitivity pattern of microbial isolates. Sixty patients with central venous catheter inserted and admitted under ICU having signs and symptoms of septicaemia post 48 hours of central venous catheter insertion were included. The rate of CRBSI was assessed by paired quantitative blood culture method in the CVC and peripheral vein. The CRB...
Indian journal of medical microbiology
Central venous catheters (CVCs) though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI) resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC-BSI) in the intensive care unit (ICU) patients and studied the formation of biofilm in CVCs. The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC) and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO) and Gram staining methods. Biofilm production in catheters was detected by 'tissue culture plate' (TCP) method. The results were analysed using the computer-based program statistical package for the social sciences (SPSS). In 25/115 patients, defin...
Risk factors and preventive measures for catheter-related bloodstream infections
Jornal de Pediatria, 2011
Objective: To review the risk factors of central venous catheter-related bloodstream infection and the recommendations for its prevention. Sources: PubMed, Cochrane Collaboration and Bireme were reviewed using the following inclusion criteria: studies published between 2000 and 2010, study design, hospitalized pediatric population with central venous catheters and studies about central venous catheter-related bloodstream infection. In addition, reference documents were retrieved from the Centers for Disease Control and Prevention and the Brazilian Health Surveillance Agency. Summary of the findings: Associated risk factors were: duration of central venous catheter use; length of hospitalization time; long-term indwelling central venous catheter; insertion of central venous catheter in intensive care unit; nonoperative cardiovascular disease; parenteral nutrition; and administration of blood products. The preventive measures recommended by studies in the literature are: development of records and multidisciplinary guidelines of care for central venous catheter insertion and maintenance; correct use of central venous catheter insertion technique; use of chlorhexidine-impregnated dressings; early catheter removal; and adoption of continued education programs for the healthcare team. Conclusion: The control of risk factors may lead to a reduction of 40% or greater in the incidence of catheterrelated bloodstream infection. Insertion surveillance and special attention to central venous catheter in pediatric populations should guide the standardization of healthcare routines to achieve standards for comparisons within and between institutions. J Pediatr (Rio J). 2011;87(6):469-77: Infection, central venous catheter, surveillance. Suggested citation: Rosado V, Romanelli RM, Camargos PA. Risk factors and preventive measures for catheter-related bloodstream infections. J Pediatr (Rio J). 2011;87(6):469-77.
Blood stream infections associated with central and peripheral venous catheters
BMC Infectious Diseases, 2019
Background The purposes of this study were to determine the incidence of central and peripheral venous catheter-related bacteraemias, the relationship between the suspected and final confirmed bacteraemia origins, and the differences in microbiological, epidemiological, clinical, and analytical characteristics between the groups, including evolution to death. Methods This was a 7-year descriptive retrospective populational study of all bloodstream infections, comparing central (CB) and peripheral (PB) venous catheter-related bacteraemias in patients older than 15 years. Results In all, 285 catheter-related bacteraemia patients, 220 with CBs (77.19%) and 65 with PBs (22.81%), were analysed among 1866 cases with bloodstream infections. The cumulative incidence per 1000 patients-day of hospital stay was 0.36 for CB and 0.106 for PB. In terms of the suspected origin, there was less accuracy in diagnosing catheter-related bloodstream infections (68. 2%) than those of other origins (78. 4...
Prevention of catheter-related blood stream infection: back to basics?
Surgical Infections, 2011
Background: Central venous catheter (CVC)-related infections are a substantial problem in the intensive care unit (ICU). Our infection control team initiated the routine use of antiseptic-coated (chlorhexidine-silver sulfadiazine; Chx-SS) CVCs in our adult ICUs to reduce catheter-associated (CA) and catheter-related (CR) blood stream infection (BSI) as we implemented other educational and best practice standardization strategies. Prior randomized studies documented that the use of Chx-SS catheters reduces microbial colonization of the catheter compared with an uncoated standard (Std) CVC but does not reduce CR-BSI. We therefore implemented the routine use of uncoated Std CVCs in our surgical ICU (SICU) and examined the impact of this change. Hypothesis: The use of uncoated Std CVCs does not increase CR-BSI rate in an SICU. Methods: Prospective evaluation of universal use of uncoated Std CVCs, implemented November 2007 in the SICU. The incidences of CA-BSI and CR-BSI were compared during November 2006-October 2007 (universal use of Chx-SS CVCs) and November 2007-October 2008 (universal use of Std CVCs) by t-test. The definitions of the U.S. Centers for Disease Control and Prevention were used for CA-BSI and CR-BSI. Patient data were collected via a dedicated Acute Physiology and Chronic Health Evaluation (APACHE) III coordinator for the SICU. Results: Annual use of CVCs increased significantly in the last six years, from 3,543 (2001) to 5,799 (2006) total days. The APACHE III scores on day 1 increased from a mean of 54.4 in 2004 to 55.6 in 2008 (p ¼ 0.0010; 95% confidence interval [CI] 1.29-5.13). The mean age of the patients was unchanged over this period, ranging from 58.2 to 59.6 years. The Chx-SS catheters were implemented in the SICU in 2002. Data regarding the specific incidence of CR-BSI were collected beginning at the end of 2005, with mandatory catheter tip cultures when CVCs were removed. Little difference was identified in the incidence of BSI between the interval with universal Chx-SS use and that with Std CVC use. (Total BSI 0.7 vs. 0.8 per 1,000 catheter days; CA-BSI 0.5 vs. 0.8 per 1,000 catheter days; CR-BSI 0.2 vs. 0 per 1,000 catheter days.) No difference was seen in the causative pathogens of CA-BSI or CR-BSI. Conclusion: Eliminating the universal use of Chx-SS-coated CVCs in an SICU with a low background incidence of CR-BSIs did not result in an increase in the rate of CR-BSIs. This study documents the greater importance of adherence to standardization of the processes of care related to CVC placement than of coated CVC use in the reduction of CR-BSI. C entral venous catheters (CVCs) can be life-saving for those who require central access for medications, fluids, and nutrition, but their use is not without risk. In particular, catheter-related (CR) infections are a significant source of morbidity and death in hospitalized patients [1]. The U.S. Centers for Disease Control and Prevention (CDC) estimates Departments of
The Medical journal of Australia, 2007
To evaluate a hospital-wide surveillance and intervention program introduced to reduce the incidence of bloodstream infections (BSIs) caused by intravascular (IV) catheters. Prospective surveillance of all inpatients and outpatient attendees with positive blood cultures (both hospital-onset and community-onset) at a 500-bed tertiary referral hospital from 1998 to 2005. Prompt review of all positive blood cultures with identification of BSIs due to IV catheters and associated preventable factors; weekly team meetings and regular reports to clinical areas, with assistance to implement targeted interventions. Number of BSI episodes due to IV catheters per year. There were 491 BSI episodes due to IV catheters, mainly central venous catheters. Episodes per year fell from 110 in 1998 to 48 in 2005 (from 32% of all BSI episodes to 14%; a > 50% reduction). From 1998 to 2005, the rate per 1000 discharges fell from 2.3 to 0.9 (P for trend < 0.0005) and the rate per 1000 patient-days fel...