Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units.
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.
Alonso-Echanove
Juan
J
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Edwards
Jonathan R
JR
Richards
Michael J
MJ
Brennan
Patrick
P
Venezia
Richard A
RA
Keen
Janet
J
Ashline
Vivian
V
Kirkland
Kathy
K
Chou
Ellen
E
Hupert
Mark
M
Veeder
Abigail V
AV
Speas
Janice
J
Kaye
Judy
J
Sharma
Kailash
K
Martin
Aliki
A
Moroz
V Dianne
VD
Gaynes
Robert P
RP
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
D000900:Anti-Bacterial Agents