title: Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study.
abstract: OBJECTIVE
  To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU).
  
  
  METHODS
  Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003.
  
  
  METHODS
  Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri. PATIENTS; All patients admitted to 4 general medical wards.
  
  
  RESULTS
  A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place.
  
  
  CONCLUSIONS
  Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.forename: Carole
authors.initials: C
authors.lastname: Leone
authors.forename: Marilyn
authors.initials: M
authors.lastname: Jones
authors.forename: Deborah
authors.initials: D
authors.lastname: Nihill
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology*; D006757:Hospital Units / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008923:Missouri / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*