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Risk factor for Central Venous Catheter-Related Infections in Surgical and Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Maria Luisa Moro ,
Egidio Franco Vigano ,
Alessandro Cozzi Lepri  and
The Central Venous Catheter-Related Infections Study Group
Maria Luisa Moro*
Affiliation:
Istituto Superiore di Sanità, Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome, Italy
Egidio Franco Vigano
Affiliation:
Laboratorio di Microbiologia, Ospedale San Gerardo, Monza, Italy
Alessandro Cozzi Lepri
Affiliation:
Istituto Superiore di Sanità, Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome, Italy
*
Istituto Superiore di Sanità, laboratorio di Epidemiologia e Biostatistica, Via le Regina Elena, 299, 00161, Rome, Italy
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Abstract

Objective:

To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization.

Design:

Prospective multicenter cohort study.

Setting:

Two university teaching hospitals and five large nonteaching hospitals.

Patients:

Patients admitted to intensive care units or surgical units and exposed to short-term CVCs.

Results:

Of 623 catheterization episodes, 9.3% were associated with catheter-related infections (CRI). The skin at the catheter site was frequently colonized (16.2%) and was the potential source of infection in 56.1% of the cases, mostly local infections. The hub was colonized less frequently (3.5%) but was responsible for systemic infections more frequently

The following variables were independently associated with CRI: duration of catheterization (for 7 to 14 days, odds ratio [OR], 3.9; 95% confidence interval [CI]95, 1.4 to 10.7; and for >14 days, OR, 5.1; CI95, 1.7 to 15.4), coronary care unit service (OR, 6.7; CI95, 1.1 to 42.9) or surgery service (OR, 4.4; CI95, 1.03 to 18.5), second episode of catheterization (OR, 7.6; CI95, 1.8 to 32.3), skin colonization at the insertion site (OR, 56.5; CI95, 10.8 to 296), and hub colonization (OR, 17.9; CI95, 2.4 to 132).

The risk associated with skin colonization varied with use of jugular access or simultaneous colonization of the hub. When only symptomatic CRI was considered, the risk associated with hub colonization was consistently higher (OR, 36.6; 7 to 190) than that associated with skin colonization (OR, 3.2; CI95, 0.7 to 14).

Age, transparent dressing, jugular insertion, male gender, duration of catheterization, and hub colonization were independent risk factors for skin colonization. The effect of age varied by type of dressing and vice versa; the effect of jugular access varied by sex; and the effect of transparent dressing varied by length of catheter-ization and vice versa.

Total parenteral nutrition and skin colonization were independently associated with an increased risk of hub colonization.

Conclusions:

Skin and hub colonization are the two major determinants for endemic CRIs; colonization of the hub, however, is more frequently associated with more severe infections. In order to reduce CRIs, more efforts should be focused on understanding which factors increase the risk of colonization both of the skin and of the hub.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 4 , April 1994 , pp. 253 - 264
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1. Maki, DG. Pathogenesis, prevention and management of infections due to intravascular devices used for infusion therapy. In: Bisno, Al, Waldvogel, FA, Infections Associated with Indwelling Medical Devices. Washington, DC: American Society for Microbiology; 1989:161–177.Google Scholar
2. Banerjee, S, Emori, TG, Culver, DH, et al. Secular trends in nosocomial bloodstream infections in the United States, 1980-1989. Am J Med 1991:91:86S–89S.CrossRefGoogle ScholarPubMed
3. Raad, II, Bodey, GP. Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992;15:197–210.Google Scholar
4. Hampton, AA, Sherertz, RJ. Vascular-access infections in hospitalized patients. Surg Clin North Am 1988;68:57–71.CrossRefGoogle ScholarPubMed
5. Simmons, BF! Guideline for prevention of intravascular infections. Infect Control 1982;3:61–72.Google Scholar
6. Johnson, A, Oppenheim, BA. Vascular catheter-related sepsis: diagnosis and prevention. J Hosp Infect 1992;20:67–78.Google Scholar
7. Maki, DG. Infections caused byintravascular devices: pathogenesis, strategies for prevention. In: Maki, DG. Improving Catheter Site Care-International Congress and Symposium Series No. 179. London: Royal Society of Medicine Services; 1991:3–27.Google Scholar
8. Maki, DG. Jarrett, F, Sarafin, HW. A semiauantitative method for identification of catheter-related infection-in bum patients. J Surg Res 1977;22:513–520.CrossRefGoogle Scholar
9. Cleri, DJ, Corrado, ML, Seligman, SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis 1980;141:781–786.CrossRefGoogle ScholarPubMed
10. Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.CrossRefGoogle Scholar
11. Fan, ST, Teoh-Chan, CH, Lau, KF, Chu, KW, Kwan, AKB, Wong, KK. Predictive value of surveillance skin and hub cultures in central venous catheters sepsis. J Hosp Infect 1988;12:191–198.CrossRefGoogle ScholarPubMed
12. Plit, ML, Lipman, J, Eidelman, J, Gavaudan, J. Catheter-related infection. A plea for consensus with review and guidelines. Int Care Med; 14:503–509.CrossRefGoogle Scholar
13. BMDP Statistical Software, Inc., Los Angeles, CA; 1990.Google Scholar
14. Hosmer, DW, Lemeshow, S. Applied logistic Regression. New York, NY:John Wiley & Sons, 1989.Google Scholar
15. Nystrom, B, Larsen, SO, Dankert, J, et al. Bacteraemia in surgical patients with intravenous devices: a European multicenter incidence study. J Hosp Infect 1983;4:338–349.CrossRefGoogle Scholar
16. Brun-Buisson, C, Abrouk, F, Legrand, P, Huet, Y, Larabi, S, Rapin, M. Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 1987;147:873–877.Google Scholar
17. Sherertz, RJ, Raad, II, Belani, A, et al. Three-year experience with sonicated vascular catheter cultures in a clinical microbiology laboratory. J Clin Microbiol 1990;28:76–82.Google Scholar
18. Richet, H, Hubert, G, Nitemberg, A, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care units patients. J Clin Microbiol 1990:28:2520–2525.CrossRefGoogle Scholar
19. Maki, DG, Ringer, M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. JAMA 1987;258:2396–2403.CrossRefGoogle ScholarPubMed
20. Mermel, LA, McCormick, R, Springman, SR, Maki, DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991;91 (suppl3B):197S–205S.Google Scholar
21. Widmer, AF, Nettleman, M, Flint, K, Wenzel, RI? The clinical impact of culturing central venous catheters. A prospective study. Arch Intern Med 1992;152:1299–1302.Google Scholar
22. Hambraeus, A, Hobom, J, Whyte, W. Skin sampling: validation of pad method and comparison with commonly used methods. J Hosp Infect 1990;16:19–27.Google Scholar
23. Cercenado, E, Ena, J, Rodriguez-Créixems, M, Romer, I, Bouza, E. A conservative procedure-for the diagnosis of catheter-related infections. Arch Intern Med 1990:150:1417–1420.Google Scholar
24. Conly, JM, Grieves, K, Peters, B. A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. J Infect Dis 1989;159:310–319.CrossRefGoogle ScholarPubMed
25. Maki, DG, Will, L. Risk factors for central venous catheter-related infections within the ICU. A prospective study of 345 catheters. Presented at the Third Decennial International Conference on Nosocomial Infections; July 31-August 3, 1990; Atlanta, GA. Abstract 54.Google Scholar
26. Franceschi, D, Gerding, RL, Phillips, G, Fratianne, RB. Risk factors associated with intravascular catheter infections in burned patients: a prospective, randomized study. J Trauma 1989;29:811–816.CrossRefGoogle ScholarPubMed
27. Armstrong, CW, Mayhall, CG, Miller, KB, et al. Clinical predictors of infection of central venous catheters used for total parenteral nutrition. Infect Control Hosp Epidemiol 1990;11:71–78.CrossRefGoogle ScholarPubMed
28. Gill, RT, Kruse, JA, Thill-Beharozian, MC, Carlson, RW. Triple-vs single-lumen central venous catheters: a prospective study in a critically ill population. Arch Intern Med 1989;149:1139–1143.CrossRefGoogle Scholar
29. Hampton, AA, Sherertz, RJ. Vascular-access infections in hospitalized patients. Surg Clin North Am 1988;68:57–71.CrossRefGoogle ScholarPubMed
30. Cobb, DK, High, KP, Sawyers, 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
31. Lederle, FA, Parenti, CM, Berskow, LC, Ellingson, KJ. The idle intravenous catheter. Ann Intern Med 1992;116:737–738.Google Scholar
32. Moro, ML, Melotti, R, Ippolito, G. Indagine nazionale sulle misure di contrallo delle infezioni ospedaliere in terapia intensiva. Minerva Anestesiologica 1992;58:1–12.Google Scholar
33. Ena, J, Cercenado, E, Martinez, D, Bouza, E. Cross-sectional epidemiology of phlebitis and catheter-related infections. Infect Control Hosp Epidemiol 1992; 13:15–20.CrossRefGoogle ScholarPubMed
34. Gross, PA, Levine, JE Infections in the elderly In: Wenzel, RI? Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1987.Google Scholar
35. Garibaldi, RA, Burke, JP, Britt, MR, Miller, WA, Smith, CB. Meatal colonization and catheter-associated bacteriuria. N Engl J Med 1980;303:316–318.Google Scholar
36. Pinilla, JC, Ross, DE Martin, T, Crump, H. Study of the incidence of intravascular catheter infection and associated septicemia in critically ill patients. Crit Care Med 1983:11:21–25.Google Scholar
37. Maki, DG. Marked differences in skin colonization of insertion sites for central venous, arterial and peripheral IV catheters. The major reason for differing risks of catheter-related infection? Presented at the Third Decennial International Conference on Nosocomial Infections; July 31-August 3, 1990; Atlanta, Georgia. Abstract 82.Google Scholar
38. Hoffmann, KK, Weber, DJ, Samsa, GP, Rutala, WA. Transparent polyurethane film as an intravenous catheter dressing. A metaanalysis on the infection risks. IAMA 1992:267:2072–2076.Google Scholar
39. Holmstrom, B, Svensson, C. Tegaderm’ dressings prevent recolonization of chlorexidine-treated skin. J Hosp Infect 1987;10:287–291.Google Scholar
40. Hilton, E, Haslett, TM, Borenstein, MT, Tucci, V, Isenberg, HD, Singer, C. Central catheter infections: single- versus triple-lumen catheters. Am J Med 1988;84:667–672.Google Scholar
41. Wolfe, BM, Ryder, M, Nishikawa, R, Halsted, CH. Complications of parenteral nutrition. Am J Surg 1986;152:93–94.Google Scholar
42. Yeung, C, May, J, Hughes, R. Infection rate for single lumen v triple lumen subclavian catheters. Infect Control Hosp Epidemiol 1988;9:154–158.Google Scholar
43. Miller, JJ, Venus, B, Matthew, M. Comparison of the sterility of long-term central catheterization using single-lumen, triple-lumen and pulmonary artery catheters. Crit Care Med 1984;12:634–637.CrossRefGoogle ScholarPubMed
44. Kelly, CS, Ligas, JR, Smith, CA, et al. Sepsis due to triple-lumen central venous catheters. Surg Gynecol Obstet 1986;163:14–16.Google Scholar
45. Johnson, BH, Rypins, EB. Single-lumen vs double-lumen catheters for total parenteral nutrition. A randomized, prospective trial. Arch Surg 1990;125:990–992.Google Scholar
46. Hill, RLR, Fisher, AP, Ware, RJ, Wilson, S, Casewell, MW. Mupirocin for the reduction of colonization of internal jugular cannulae: a randomized controlled trial. J Hosp Infect 1990;15:311–321.Google Scholar
47. Maki, DG, Cobb, L, Garman, JK, Shapiro, JM, Ringer, M, Helgerson, RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: A prospective randomized multicenter trial. Am J Med 1988;85:307–314.CrossRefGoogle ScholarPubMed
48. Kamal, GD, Pfaller, MA, Rempe, LE, Jebson, PJR. Reduced intravascular catheter infection by antibiotic bonding. JAMA 1991;265:2364–2368.Google Scholar
49. Starter, AT, Ward, H, Waterfield, AH, Sim, AJW. Junctional care: the key to prevention of catheter sepsis in intravenous feeding. JPEN J Parenter Enteral Nutr 1987;11:159–162.Google Scholar
50. Segura, M, Alia, C, Valverde, J, Franch, G, Torres-Rodriguez, JM, Sitges-Serra, A. Assessment of a new hub design and the semiquantitative catheter culture method using an in vivo experimental model of catheter sepsis. J Clin Microbiol 1990;28:2551–2554.Google Scholar