Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-18T14:13:22.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Catheter-Associated Bloodstream Infections in General Medical Patients Outside the Intensive Care Unit: A Surveillance Study

Published online by Cambridge University Press:  02 January 2015

Jonas Marschall ,
Carole Leone ,
Marilyn Jones ,
Deborah Nihill ,
Victoria J. Fraser  and
David K. Warren
Jonas Marschall
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Carole Leone
Affiliation:
BJC Healthcare, Saint Louis, Missouri
Marilyn Jones
Affiliation:
BJC Healthcare, Saint Louis, Missouri
Deborah Nihill
Affiliation:
BJC Healthcare, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri BJC Healthcare, Saint Louis, Missouri
David K. Warren*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri BJC Healthcare, Saint Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110 (dwarren@im.wustl.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU).

Design.

Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003.

Setting.

Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri.

Patients.

All patients admitted to 4 general medical wards.

Results.

A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place.

Conclusions.

Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 905 - 909
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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. Jarvis, WR. Benchmarking for prevention: the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) system experience. Infection 2003;31(suppl 2):44–48.Google Scholar
2. Pittet, D. Infection control and quality health care in the new millennium. Am J Infect Control 2005;33:258–267.Google Scholar
3. Gastmeier, P, Geffers, C, Brandt, C, et al. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 2006;64:16–22.CrossRefGoogle ScholarPubMed
4. Lorente, L, Villegas, J, Martin, MM, limenez, A, Mora, ML. Catheter-related infection in critically ill patients. Intensive Care Med 2004;30:1681–1684.Google Scholar
5. Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014–2020.CrossRefGoogle ScholarPubMed
6. Warren, DK, Yokoe, DS, Climo, MW, et al. Preventing catheter-associated bloodstream infections: a survey of policies for insertion and care of central venous catheters from hospitals in the prevention epicenter program. Infect Control Hosp Epidemiol 2006;27:8–13.Google Scholar
7. Climo, M, Diekema, D, Warren, DK, et al. 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. Infect Control Hosp Epidemiol 2003;24:942–945.Google Scholar
8. Trick, WE, Vernon, MO, Welbel, SF, Wisniewski, MF, Jernigan, JA, Weinstein, RA. Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol 2004;25:266–268.CrossRefGoogle ScholarPubMed
9. Vonberg, RP, Behnke, M, Geffers, C, et al. Device-associated infection rates for non-intensive care unit patients. Infect Control Hosp Epidemiol 2006;27:357–361.Google Scholar
10. Kahn, MG, Steib, SA, Fraser, VJ, Dunagan, WC. An expert system for culture-based infection control surveillance. Proc Annu Symp Comput Appl Med Care 1993;171–175.Google Scholar
11. Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Infectious Diseases Society of America; American College of Critical Care Medicine; Society for Healthcare Epidemiology of America. Clin Infect Dis 2001;32:1249–1272.Google Scholar
12. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
13. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51:1–29.Google Scholar
14. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crif Care Med 1999;27:887–892.Google Scholar
15. Ramirez Barba, EJ, Rosenthal, VD, Higuera, F, et al. Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals. Am J Infect Control 2006;34:244–247.Google Scholar
16. Moreno, CA, Rosenthal, VD, Olarte, N, et al. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol 2006;27:349–356.Google Scholar
17. Gowardman, JR, Montgomery, C, Thirlwell, S, et al. Central venous catheter-related bloodstream infections: an analysis of incidence and risk factors in a cohort of 400 patients. Intensive Care Med 1998;24:1034–1039.Google Scholar
18. Suljagic, V, Cobeljic, M, Jankovic, S, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. Am J Infect Control 2005;33:333–340.Google Scholar
19. Mnatzaganian, G, Galai, N, Sprung, CL, et al. Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards. J Hosp Infect 2005;59:331–342.Google Scholar
20. NNIS System. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003;31:481–498.Google Scholar
21. Wischnewski, N, Kampf, G, Gastmeier, P, et al. Prevalence of primary bloodstream infections in representative German hospitals and their association with central and peripheral vascular catheters. Zentralbl Bak-teriol 1998;287:93–103.Google Scholar
22. Memish, ZA, Arabi, Y, Cunningham, G, et al. Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study. EPIC Group. Am J Infect Control 2003;31:237–242.Google Scholar
23. Rosenthal, VD, Guzman, S, Pezzotto, SM, Crnich, CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control 2003;31:405–409.Google Scholar
24. Warren, DK, Zack, JE, Mayfield, JL, et al. The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest 2004;126:1612–1618.Google Scholar
25. Lobo, RD, Levin, AS, Gomes, LM, et al. Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. Am J Infect Control 2005;33:83–87.Google Scholar
26. Trick, WE, Zagorski, BM, Tokars, JI, et al. Computer algorithms to detect bloodstream infections. Emerg infect Dis 2004;10:1612–1620.Google Scholar
27. Institute for Healthcare Improvement. 5 Million Lives Campaign Web site. Available at: http://www.ihi.org/ihi/programs/campaign. Accessed May 20, 2007.Google Scholar