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01-10-2012 | Original

A multicentre analysis of catheter-related infection based on a hierarchical model

Authors: J. F. Timsit, F. L‘Hériteau, A. Lepape, A. Francais, S. Ruckly, A. G. Venier, P. Jarno, S. Boussat, B. Coignard, A. Savey

Published in: Intensive Care Medicine | Issue 10/2012

Abstract

Purpose

To decrease intensive care unit (ICU)-acquired catheter-related infections (CRI), it is essential that healthcare workers receive training and that quality improvement programmes are in place. The aim of our study was to evaluate risk factors for catheter colonisation and infection, focussing specifically on local care bundles.

Methods

Data were collected prospectively in 51 ICUs [7,188 patients, 8,626 central venous catheters (CVCs)] during two 6-month periods in 2007 and 2008, using a standardized questionnaire on catheter insertion, care and removal. Colonisation and CRI incidence were 6.1 and 2.2/1,000 CVC-days, respectively. A hierarchical mixed logistic model was used to identify risk factors for CRI and colonisation.

Results

Written CVC protocols were available in 46 (90 %) ICUs and were strictly followed in 38 ICUs. Factors significantly associated with CRI fell into three overall categories: (1) patient-related factors—immunosuppression [odds ratio (OR) 1.42, p = 0.02], medical diagnosis at admission (OR 1.64, p = 0.03) and trauma patient (OR 2.54, p < 0.001); (2) catheter-related factors—catheter rank (OR 1.7, p < 0.0001, non-subclavian catheter (OR 2.1, p < 0.001) and longer time with the catheter (p < 10⁻⁴); (3) centre-related factors—quantitative tip culture method (OR 2.55, p = 0.005) and alcohol-based povidone-iodine [OR 0.68, 95 % confidence interval (CI) 0.49–0.96] or alcohol-based chlorhexidine preparations (OR 0.69, 95 % CI 0.34–1.39) as compared to an aqueous povidone-iodine preparation (p < 0.001).

Conclusions

We identified several risk factors for CRI that are amenable to improvement (preference for the subclavian route and use of an antiseptic solution containing alcohol). However, several patient-related factors were also found, and the use of quantitative catheter culture methods increased culture sensitivity, thereby increasing the CRI rate. Case-mix issues and the culture method should be taken into account when assessing the risk of CRI across centres.

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Title: A multicentre analysis of catheter-related infection based on a hierarchical model
Authors: J. F. Timsit
F. L‘Hériteau
A. Lepape
A. Francais
S. Ruckly
A. G. Venier
P. Jarno
S. Boussat
B. Coignard
A. Savey
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 10/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2645-6

At a glance: The STEP trials

Springer Medicine

A multicentre analysis of catheter-related infection based on a hierarchical model

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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