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Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Juan Alonso-Echanove ,
Jonathan R. Edwards ,
Michael J. Richards ,
Patrick Brennan ,
Richard A. Venezia ,
Janet Keen ,
Vivian Ashline ,
Kathy Kirkland ,
Ellen Chou  and
Mark Hupert
...Show all authors
Juan Alonso-Echanove
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Michael J. Richards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Patrick Brennan
Affiliation:
Infection Control Department, University of Pennsylvania, Philadelphia, Pennsylvania
Richard A. Venezia
Affiliation:
Department of Epidemiology, Albany Medical Center, Albany, New York
Janet Keen
Affiliation:
Epidemiology/Infection Control Department, University Hospital of Augusta, Augusta, Georgia
Vivian Ashline
Affiliation:
Epidemiology/Infection Control Department, University Hospital of Augusta, Augusta, Georgia
Kathy Kirkland
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Ellen Chou
Affiliation:
Infection Control Program, The Gennessee Hospital, via Health, Rochester, New York
Mark Hupert
Affiliation:
Infection Control Department, University of Pennsylvania, Philadelphia, Pennsylvania
Abigail V. Veeder
Affiliation:
Department of Epidemiology, Albany Medical Center, Albany, New York
Janice Speas
Affiliation:
Infection Control Department, Saint Joseph's Hospital of Atlanta, Atlanta, Georgia
Judy Kaye
Affiliation:
Infection Control Department, Saint Joseph's Hospital of Atlanta, Atlanta, Georgia
Kailash Sharma
Affiliation:
Epidemiology/Infection Control Department, University Hospital of Augusta, Augusta, Georgia
Aliki Martin
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
V. Dianne Moroz
Affiliation:
Infection Control Program, The Gennessee Hospital, via Health, Rochester, New York
Robert P. Gaynes*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Mailstop E-55, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333
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Abstract

Background:

Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.

Methods:

We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.

Results:

A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days; P = .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by “float” nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P = .0001), patient cared for by a float nurse for more than 60% of CVC-days (P = .0019), no antibiotics administered to the patient within 48 hours of insertion (P = .0001), and patient unarousable for 70% or more of the duration of the CVC (P = .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P = .0001).

Conclusions:

Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 916 - 925
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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