FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN AN INTENSIVE CARE UNIT

Introduction: To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate. Material and Methods: A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2). Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.

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Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

Infection Control and Hospital Epidemiology ◽

10.1086/590356 ◽

2008 ◽

Vol 29 (10) ◽

pp. 947-950 ◽

Cited By ~ 25

Author(s):

Duk-hee Lee ◽

Koo Young Jung ◽

Yoon-Hee Choi

Keyword(s):

Multivariate Analysis ◽

Mortality Rate ◽

Central Venous Catheter ◽

Confidence Interval ◽

Bloodstream Infection ◽

Odds Ratio ◽

Venous Catheter ◽

Central Venous ◽

Factors Associated ◽

Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

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Use of educational intervention in reduction of the rate of bloodstream infection associated with the central venous catheter in intensive care unit of adults: integrative review

BMC Proceedings ◽

10.1186/1753-6561-5-s6-p56 ◽

2011 ◽

Vol 5 (S6) ◽

Author(s):

RA Lacerda ◽

JM Jardim ◽

BN Kosar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Educational Intervention ◽

Venous Catheter ◽

Integrative Review ◽

Central Venous

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Factors Associated with Time to Acquisition of Bloodstream Infection in a Pediatric Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/650450 ◽

2010 ◽

Vol 31 (3) ◽

pp. 249-255 ◽

Cited By ~ 10

Author(s):

Maria Júlia Gonçalves de Mello ◽

Maria de Fátima Pessoa Militão de Albuquerque ◽

Ricardo Arraes de Alencar Ximenes ◽

Heloísa Ramos Lacerda ◽

Eduardo Jaime Seara Ferraz ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Pediatric Intensive Care Unit ◽

Cox Model ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Venous ◽

Factors Associated

Objective.To evaluate the risk factors that influence time to acquisition of a laboratory-confirmed bloodstream infection (LCBI).Design.Prospective cohort study with an 18-month follow-up.Setting.A 16-bed medical and/or surgical pediatric intensive care unit that cares for patients of the Brazilian Public Health System exclusively.Patients.We included children from 0 to 18 years old who were represented by 875 consecutive admissions to the pediatric intensive care unit from January 1, 2005, through June 30, 2006. The children from all but 5 (0.6%) of the admissions were followed up until discharge or death. The majority (506 [58.2%]) were hospitalized for surgical pathology, and 254 (29.2%) underwent heart surgery.Methods.We used a standardized questionnaire and data collection from daily charts. Information on risk factors was collected before the onset of first LCBI. Survival analysis was performed using the Kaplan-Meier method. The effect of the variables on the risk of LCBI each day was estimated through a Cox model fitting.Results.Fifty-seven children (6.6%) developed an LCBI, 54 (94.7%) of whom made use of a central venous catheter. LCBI incidence was 11.27 episodes/1,000 patient-days and 17.92 episodes/1,000 patient-days when associated with a central venous catheter. Factors associated with time to the first LCBI in the Cox model were age less than 2 years (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.02–3.89), malnutrition (HR, 1.74; 95% CI, 1.01–3.00), use of a central venous catheter (HR, 4.36; 95% CI, 1.30–14.64), use of antibiotics before admission (HR, 0.58; 95% CI, 0.33–0.98), and use of transfused blood products (HR, 0.40; 95% CI, 0.22–0.74).Conclusion.Factors associated with time to acquisition of LCBI were age less than 2 years, weight-for-age z score less than −2, and the use of a central venous catheter. Therefore, intensification of LCBI prevention efforts in patients with these characteristics is fundamental.

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Nonuniform Risk of Bloodstream Infection with Increasing Central Venous Catheter-Days

Infection Control and Hospital Epidemiology ◽

10.1086/502608 ◽

2005 ◽

Vol 26 (8) ◽

pp. 715-719 ◽

Cited By ~ 33

Author(s):

Mary-Louise McLaws ◽

Geoffrey Berry

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Venous Catheter ◽

Catheter Removal ◽

True Probability ◽

Central Venous

AbstractObjective:To determine whether the conventional rate for central venous catheter (CVC)-associated bloodstream infection (BSI) accurately reflects risk for patients exposed for a variety of in situ periods.Patients and Methods:Intensive care unit patients (n = 1,375) were monitored for 7,467 CVC-days. They were monitored until catheter removal, until diagnosis of CVC-associated BSI, or for 24 hours after discharge.Results:The BSI rate was 3.7 per 1,000 CVC-days. Ninety-three percent of these patients had CVCs in situ for 1-15 days. These patients were exposed to 59.7% of all CVC-days; the remaining 7% were exposed to 40.3% of all CVC-days. BSI rates stratified by exposure periods of 1-5 and 6-15 days were 2.1 and 4.5 per 1,000 CVC-days, respectively. The rates for 16-30 and 31-320 days were 10.2 and 2.1 per 1,000 CVC-days, respectively. The probability of BSI with a CVC in situ was 6 in 100 by day 15, 14 in 100 by day 25, 21 in 100 by day 30, and 53 in 100 by day 320.Conclusion:The conventional aggregated rate better reflects the risk for the majority of patients rather than for patients exposed to the majority of CVC-days. It does not reflect the true probability of risk for all exposures, especially beyond 30 days. CVCs in situ from 1 to 15 days had less risk of BSI than CVCs in situ more than 15 days, which may explain why scheduled CVC replacement at days 5 to 7 has not been found beneficial.

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