Surveillance Program of Bloodstream Infections Associated with Short- and Long-Term Central Venous Catheter with Observation of Recommendation Compliance at Insertion and Maintenance

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, assesing the observation of current evidence-based recommendations compliance for catheter insertion (RCCI) and maintenance (RCCM).

Objective: To assess the efectivity after eighteen months of program initiation.

Methods: We studied prospectively all CVCs inserted between February 2009 and June 2010. 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 and RCCM in a sample of catheter insertion and maintenance procedures, collecting use of maximal sterile barrier precautions, hand hygiene and chlorhexidine antisepsis.

Results: During the observed time period, 3155 short-term and 490 long-term CVC were inserted.

Short-term Catheters: median duration 8 days (P25-P75: 4-12); insertion site: jugular 49.6%, femoral 19.6%, subclavian 21.6%, Other 9.2%; CVC type: Standard 75%, Swan Ganz 11.2%, Other 13.8%; there were 5.49 CRI per 1000 catheter-days (S. epidermidis 41%, P. aeruginosas 19%, other gram-positive 13%, gram-negative bacilli 19% and yeasts 8%). Long-term Catheters: median duration 180 days (P25-P75: 163-180); CVC type: Port-a-cath 43.5%, Hickman 21%, Permcath 35.5%; there were 0.37 CRI per 1000 catheter-days (S. epidermidis 43% other gram-positive 21.5%, gram-negative bacilli 28.5% and yeasts 7%). Of 152 CVC insertions observed during the time period, appropriate hand hygiene occurred in 86.8%, use of chlorhexidine in 35.5%, use of sterile gown in 98.7%, and sterile technique break in 10.5%. Maintenance (n=110): hand hygiene 42.1%; disinfection of ports with alcoholic solution of chlorhexidine 32.5%.

The CRI per semester were for Short-term catheters: 1ºsem 6.36 CRI per 1000 catheter-days, 2ºsem 6.44 CRI per 1000 catheter-days (p=NS) and 3ºsem 3.74 CRI per 1000 catheter-days (p<0.015).For Long-term catheters: 1ºsem 0.55 CRI per 1000 catheter-days, 2ºsem 0,46 CRI per 1000 catheter-days (p=NS) and 3ºsem 0.18 CRI per 1000 catheter-days (p<0.041).

Conclusions: The program has been effective because the incidence of CRI has slowed in the second half of the program for long term catheters, and in the third half for both short and long term catheters.