A multicentre analysis of catheter-related infection based on a hierarchical model.
OBJECTIVE
To decrease intensive care unit (ICU)-acquired catheter-related infections (CRI), it is essential that healthcare workers receive training and that quality improvement programmes are in place. The aim of our study was to evaluate risk factors for catheter colonisation and infection, focussing specifically on local care bundles.


METHODS
Data were collected prospectively in 51 ICUs [7,188 patients, 8,626 central venous catheters (CVCs)] during two 6-month periods in 2007 and 2008, using a standardized questionnaire on catheter insertion, care and removal. Colonisation and CRI incidence were 6.1 and 2.2/1,000 CVC-days, respectively. A hierarchical mixed logistic model was used to identify risk factors for CRI and colonisation.


RESULTS
Written CVC protocols were available in 46 (90 %) ICUs and were strictly followed in 38 ICUs. Factors significantly associated with CRI fell into three overall categories: (1) patient-related factors-immunosuppression [odds ratio (OR) 1.42, p = 0.02], medical diagnosis at admission (OR 1.64, p = 0.03) and trauma patient (OR 2.54, p < 0.001); (2) catheter-related factors-catheter rank (OR 1.7, p < 0.0001, non-subclavian catheter (OR 2.1, p < 0.001) and longer time with the catheter (p < 10(-4)); (3) centre-related factors-quantitative tip culture method (OR 2.55, p = 0.005) and alcohol-based povidone-iodine [OR 0.68, 95 % confidence interval (CI) 0.49-0.96] or alcohol-based chlorhexidine preparations (OR 0.69, 95 % CI 0.34-1.39) as compared to an aqueous povidone-iodine preparation (p < 0.001).


CONCLUSIONS
We identified several risk factors for CRI that are amenable to improvement (preference for the subclavian route and use of an antiseptic solution containing alcohol). However, several patient-related factors were also found, and the use of quantitative catheter culture methods increased culture sensitivity, thereby increasing the CRI rate. Case-mix issues and the culture method should be taken into account when assessing the risk of CRI across centres.
Medical Polyvalent ICU, University Hospital Albert Michallon, Grenoble 1 University, 38000 Grenoble, France. jftimsit@chu-grenoble.fr
J F
JF
Timsit
F
F
L'Hériteau
A
A
Lepape
A
A
Francais
S
S
Ruckly
A G
AG
Venier
P
P
Jarno
S
S
Boussat
B
B
Coignard
A
A
Savey
D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000891:Anti-Infective Agents, Local