Early Results of a Surveillance Program of Bloodstream Infections Associated with Short- and Long-Term Central Venous Catheter Use

Background:

Programs that target surveillance have been effective in diminishing central venous catheter (CVC) related infections (CRI). We have initiated a surveillance program in our hospital for the prevention of CRI associated with short- and long-term CVC use, including the observation of current evidence-based recommendations compliance for catheter insertion (RCCI).

Objective:

To describe early results after the first nine months of program initiation.

Methods:

We studied prospectively all CVCs inserted between February and October 2009. For short-term CVCs a follow-up has been realized from the insertion until its withdrawal; and for long-term CVCs there has been realized a minimal follow-up of two months and a maximum of six months. Measures included the following: unit where the CVC was inserted, CVC characteristics (type, location, number of lumens), rate of infection per 1000 catheter-days, and isolated pathogen. The criteria of definition of case are those of the CDC. We directly observed RCCI in a sample of catheter insertion procedures, collecting use of maximal sterile barrier precautions, hand hygiene and chlorhexidine skin antisepsis.

Results: During the observed time period, 1634 short-term and 188 long-term CVC were inserted.

Short-term Catheters: median duration 7 days (P25-P75: 4-11); insertion site: jugular 49.8%, femoral 19.4%, subclavian 20%, Other 10.7%; CVC type: Standard 74%, Swan Ganz 11.2%, Other 14.8%; there were 5.85 CRI per 1000 catheter-days (S. epidermidis 43.2%, P. aeruginosas 12.3%, other gram-positive 14,4%, gram-negative bacilli 24% and yeasts 6.17%). Long-term Catheters: median duration 110 days (P25-P75: 78-184); CVC type: Port-a-cath 37.8%, Hickman 28.7%, Permcath 33.5%; there were 0.39 CRI per 1000 catheter-days (S. epidermidis 44% other gram-positive 22%, gram-negative bacilli 22% and yeasts 11%). Of 44 CVC insertions observed during the time period, appropriate hand hygiene occurred in 96.6%, use of chlorhexidine in 10.3%, use of sterile gown in 76.0%, and sterile technique break in 20.0%. Of 44 CVC insertions observed during the time period, appropriate hand hygiene occurred in 96.6%, use of chlorhexidine in 10.3%, use of sterile gown in 76.0%, and sterile technique break in 20.0%.

Conclusions: There are few published studies about the overall incidence of CRI at a university hospital as a whole, where are analyzed all kind of patients, different hospital units, and all types of catheters.
The incidence of CRI in our hospital is similar to other hospitals in Spain, but higher than reported by other studies.
We found significant areas for improvement in the insertion and maintenance of  CVC.
We anticipate a progressive decline in incidence with continued surveillance program implementation, and   informative reports to the units of the hospital.