title: Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group.
abstract: OBJECTIVE
  To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization.
  
  
  METHODS
  Prospective multicenter cohort study.
  
  
  METHODS
  Two university teaching hospitals and five large nonteaching hospitals.
  
  
  METHODS
  Patients admitted to intensive care units or surgical units and exposed to short-term CVCs.
  
  
  RESULTS
  Of 623 catheterization episodes, 9.3% were associated with catheter-related infections (CRI). The skin at the catheter site was frequently colonized (16.2%) and was the potential source of infection in 56.1% of the cases, mostly local infections. The hub was colonized less frequently (3.5%) but was responsible for systemic infections more frequently. The following variables were independently associated with CRI: duration of catheterization (for 7 to 14 days, odds ratio [OR], 3.9; 95% confidence interval [CI]95, 1.4 to 10.7; and for > 14 days, OR, 5.1; CI95, 1.7 to 15.4), coronary care unit service (OR, 6.7; CI95, 1.1 to 42.9) or surgery service (OR, 4.4; CI95, 1.03 to 18.5), second episode of catheterization (OR, 7.6; CI95, 1.8 to 32.3), skin colonization at the insertion site (OR, 56.5; CI95, 10.8 to 296), and hub colonization (OR, 17.9; CI95, 2.4 to 132). The risk associated with skin colonization varied with use of jugular access or simultaneous colonization of the hub. When only symptomatic CRI was considered, the risk associated with hub colonization was consistently higher (OR, 36.6; CI95, 7 to 190) than that associated with skin colonization (OR, 3.2; CI95, 0.7 to 14). Age, transparent dressing, jugular insertion, male gender, duration of catheterization, and hub colonization were independent risk factors for skin colonization. The effect of age varied by type of dressing and vice versa; the effect of jugular access varied by sex; and the effect of transparent dressing varied by length of catheterization and vice versa. Total parenteral nutrition and skin colonization were independently associated with an increased risk of hub colonization.
  
  
  CONCLUSIONS
  Skin and hub colonization are the two major determinants for endemic CRIs; colonization of the hub, however, is more frequently associated with more severe infections. In order to reduce CRIs, more efforts should be focused on understanding which factors increase the risk of colonization both of the skin and of the hub.
authors.affiliation: Istituto Superiore di Sanità, Rome, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Moro
authors.forename: E F
authors.initials: EF
authors.lastname: Viganò
authors.forename: A
authors.initials: A
authors.lastname: Cozzi Lepri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000209:etiology*; D004866:Equipment Contamination; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000382:microbiology