title: Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention.
abstract: OBJECTIVE
  To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.
  
  
  METHODS
  A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.
  
  
  METHODS
  Inpatient wards and ICUs of six large urban teaching hospitals.
  
  
  RESULTS
  At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.
  
  
  CONCLUSIONS
  Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.
authors.affiliation: Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia 23249, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Climo
authors.forename: Dan
authors.initials: D
authors.lastname: Diekema
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Loreen A
authors.initials: LA
authors.lastname: Herwaldt
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Lance
authors.initials: L
authors.lastname: Peterson
authors.forename: Theresa
authors.initials: T
authors.lastname: Plaskett
authors.forename: Connie
authors.initials: C
authors.lastname: Price
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
authors.forename: Steve
authors.initials: S
authors.lastname: Solomon
authors.forename: Jerry
authors.initials: J
authors.lastname: Tokars
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Edward
authors.initials: E
authors.lastname: Wong
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000382:microbiology / Q000706:statistics & numerical data*; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D019538:Health Care Surveys; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014600:Utilization Review