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.
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.
Climo
Michael
M
Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia 23249, USA.
Diekema
Dan
D
Warren
David K
DK
Herwaldt
Loreen A
LA
Perl
Trish M
TM
Peterson
Lance
L
Plaskett
Theresa
T
Price
Connie
C
Sepkowitz
Kent
K
Solomon
Steve
S
Tokars
Jerry
J
Fraser
Victoria J
VJ
Wong
Edward
E
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