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

  • Juan Alonso-Echanove (a1), Jonathan R. Edwards (a1), Michael J. Richards (a1), Patrick Brennan (a2), Richard A. Venezia (a3), Janet Keen (a4), Vivian Ashline (a4), Kathy Kirkland (a5), Ellen Chou (a6), Mark Hupert (a2), Abigail V. Veeder (a3), Janice Speas (a7), Judy Kaye (a7), Kailash Sharma (a4), Aliki Martin (a5), V. Dianne Moroz (a6) and Robert P. Gaynes (a1)...

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.

Copyright

Corresponding author

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

References

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

  • Juan Alonso-Echanove (a1), Jonathan R. Edwards (a1), Michael J. Richards (a1), Patrick Brennan (a2), Richard A. Venezia (a3), Janet Keen (a4), Vivian Ashline (a4), Kathy Kirkland (a5), Ellen Chou (a6), Mark Hupert (a2), Abigail V. Veeder (a3), Janice Speas (a7), Judy Kaye (a7), Kailash Sharma (a4), Aliki Martin (a5), V. Dianne Moroz (a6) and Robert P. Gaynes (a1)...

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