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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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