title: Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units.
abstract: BACKGROUND
  Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.
  
  
  METHODS
  We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.
  
  
  RESULTS
  A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days; P = .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by "float" nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P = .0001), patient cared for by a float nurse for more than 60% of CVC-days (P = .0019), no antibiotics administered to the patient within 48 hours of insertion (P = .0001), and patient unarousable for 70% or more of the duration of the CVC (P = .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P = .0001).
  
  
  CONCLUSIONS
  Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Alonso-Echanove
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Edwards
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Richards
authors.forename: Patrick
authors.initials: P
authors.lastname: Brennan
authors.forename: Richard A
authors.initials: RA
authors.lastname: Venezia
authors.forename: Janet
authors.initials: J
authors.lastname: Keen
authors.forename: Vivian
authors.initials: V
authors.lastname: Ashline
authors.forename: Kathy
authors.initials: K
authors.lastname: Kirkland
authors.forename: Ellen
authors.initials: E
authors.lastname: Chou
authors.forename: Mark
authors.initials: M
authors.lastname: Hupert
authors.forename: Abigail V
authors.initials: AV
authors.lastname: Veeder
authors.forename: Janice
authors.initials: J
authors.lastname: Speas
authors.forename: Judy
authors.initials: J
authors.lastname: Kaye
authors.forename: Kailash
authors.initials: K
authors.lastname: Sharma
authors.forename: Aliki
authors.initials: A
authors.lastname: Martin
authors.forename: V Dianne
authors.initials: VD
authors.lastname: Moroz
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gaynes
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000295:instrumentation; D010561:Personnel Staffing and Scheduling; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D000078329:Workforce
chemical_list: D000900:Anti-Bacterial Agents