Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-17T04:36:21.075Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of the Use of Central Venous Access Devices Within and Outside of the Intensive Care Unit: Results of a Survey Among Hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention

Published online by Cambridge University Press:  02 January 2015

Michael Climo ,
Dan Diekema ,
David K. Warren ,
Loreen A. Herwaldt ,
Trish M. Perl ,
Lance Peterson ,
Theresa Plaskett ,
Connie Price ,
Kent Sepkowitz  and
Steve Solomon
...Show all authors
Michael Climo*
Affiliation:
Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia
Dan Diekema
Affiliation:
University of Iowa College of Medicine, Iowa City, Iowa
David K. Warren
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Loreen A. Herwaldt
Affiliation:
University of Iowa College of Medicine, Iowa City, Iowa
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Lance Peterson
Affiliation:
Evanston Northwestern Healthcare Research Institute, Evanston, Illinois
Theresa Plaskett
Affiliation:
Memorial Sloan Kettering Hospital, New York, New York
Connie Price
Affiliation:
University of Colorado Health Sciences Center, Denver, Colorado
Kent Sepkowitz
Affiliation:
Memorial Sloan Kettering Hospital, New York, New York
Steve Solomon
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jerry Tokars
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Edward Wong
Affiliation:
Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia
*
Hunter Holmes McGuire Veteran Affairs Medical Center, 1201 Broad Rock Blvd., Section 111-C, Richmond, VA 23249
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.

Design:

A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.

Setting:

Inpatient wards and ICUs of six large urban teaching hospitals.

Results:

At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.

Conclusions:

Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 942 - 945
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002;30:458–475.Google Scholar
2. Gikas, A, Pediaditis, J, Papadakis, JA, et al. Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 2002;50:269–275.Google Scholar
3. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999;27:887–892.Google Scholar
4. Gastmeier, P, Weist, K, Ruden, H. Catheter-associated primary bloodstream infections: epidemiology and preventive methods. Infection 1999;27(suppl 1):S1–S6.Google Scholar
5. Ronveaux, O, Jans, B, Suetens, C, Carsauw, H. Epidemiology of nosocomial bloodstream infections in Belgium, 1992-1996. Eur J Clin Microbiol Infect Dis 1998;17:695–700.10.1007/s100960050163Google Scholar
6. Safdar, N, Kluger, DM, Maki, DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, non-cuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 2002;81:466–479.Google Scholar
7. Merrer, J, De Jonghe, B, Golliot, F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700–707.Google Scholar
8. Chaiyakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002;136:792–801.10.7326/0003-4819-136-11-200206040-00007Google Scholar
9. Raad, II, Hohn, DC, Gilbreath, BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15:231–238.Google Scholar
10. Veenstra, DL, Saint, S, Saha, S, Lumley, T, Sullivan, SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA 1999;281:261–267.Google Scholar
11. Moro, ML, Vigano, EF, Cozzi Lepri, A. Risk factors for central venous catheter-related infections in surgical and intensive care units. Infect Control Hosp Epidemiol 1994;15:253–264.Google Scholar
12. Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:1864–1868.Google Scholar
13. Coopersmith, CM, Rebmann, TL, Zack, JE, et al. Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med 2002;30:59–64.Google Scholar
14. Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257–266.Google Scholar
15. Sherertz, RJ, Ely, EW, Westbrook, DM, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med 2000;132:641–648.Google Scholar
16. Timsit, JF. Scheduled replacement of central venous catheters is not necessary. Infect Control Hosp Epidemiol 2000;21:371–374.Google Scholar
17. Veenstra, DL, Saint, S, Sullivan, SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA 1999;282:554–560.10.1001/jama.282.6.554Google Scholar
18. Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249–1272.Google Scholar
19. NINSS reports on surgical site infection and hospital acquired bacter-aemia. Commun Dis Rep CDR Wkly 2000;10:213, 216.Google Scholar
20. Lyytikainen, O, Lumio, J, Sarkkinen, H, Kolho, E, Kostiala, A, Ruutu, P. Nosocomial bloodstream infections in Finnish hospitals during 19992000. Clin Infect Dis 2002;35:e14–e19.Google Scholar
21. Diekema, DJ, Messer, SA, Brueggemann, AB, et al. Epidemiology of candidemia: 3-year results from the emerging infections and the epidemiology of Iowa organisms study. J Clin Microbiol 2002;40:1298–1302.Google Scholar
22. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002;30:476–489.Google Scholar