title: Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants.
abstract: OBJECTIVE
  Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI.
  
  
  METHODS
  Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs. CLABSI was defined using National Health Surveillance Network criteria. We defined dwell time as the number of days from line insertion until either line removal or day of CLABSI. We generated survival curves for each week of dwell time and estimated hazard ratios for CLABSI at each week by using a Cox proportional hazards frailty model. We controlled for postmenstrual age and year, included facility as a random effect, and generated separate models by line type.
  
  
  RESULTS
  Median postmenstrual age was 29 weeks (interquartile range 26-33). The overall incidence of CLABSI was 0.93 per 1000 catheter days. Increased dwell time was not associated with increased risk of CLABSI for PICCs. For tunneled catheters, infection incidence was significantly higher in weeks 7 and 9 compared with week 1.
  
  
  CONCLUSIONS
  Clinicians should not routinely replace uninfected PICCs for fear of infection but should consider removing tunneled catheters before week 7 if no longer needed. Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina;
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Greenberg
authors.affiliation: Department of Pediatrics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina;
authors.forename: Keith M
authors.initials: KM
authors.lastname: Cochran
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina;
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.affiliation: American Hospital Association, Chicago, Illinois;
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Edson
authors.affiliation: California Department of Health Care Services, Sacramento, California;
authors.forename: Joseph
authors.initials: J
authors.lastname: Schulman
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California;
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Santa Clara Valley Health and Hospital System, San Jose, California;
authors.forename: Balaji
authors.initials: B
authors.lastname: Govindaswami
authors.affiliation: St Joseph's Hospital, Denver, Colorado;
authors.forename: Alfonso
authors.initials: A
authors.lastname: Pantoja
authors.affiliation: Winnie Palmer Children's Hospital, Orlando, Florida;
authors.forename: Doug
authors.initials: D
authors.lastname: Hardy
authors.affiliation: USF Health, University of South Florida, Tampa, Florida;
authors.forename: John
authors.initials: J
authors.lastname: Curran
authors.affiliation: On the CUSP-Stop BSI Initiative, Honolulu, Hawaii;
authors.forename: Della
authors.initials: D
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, University of Hawaii and Kapiolani Medical Center, Honolulu, Hawaii;
authors.forename: Sheree
authors.initials: S
authors.lastname: Kuo
authors.affiliation: Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri;
authors.forename: Akihiko
authors.initials: A
authors.lastname: Noguchi
authors.affiliation: Rockford Memorial Hospital, Rockford, Illinois;
authors.forename: Patricia
authors.initials: P
authors.lastname: Ittmann
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky;
authors.forename: Scott
authors.initials: S
authors.lastname: Duncan
authors.affiliation: Beth Israel Deaconess Hospital, Boston, Massachusetts;
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Pediatrics, University of Massachusetts, Worcester, Massachusetts;
authors.forename: Alan
authors.initials: A
authors.lastname: Picarillo
authors.affiliation: Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan;
authors.forename: Padmani
authors.initials: P
authors.lastname: Karna
authors.affiliation: Children's Hospital of New Jersey, Newark, New Jersey;
authors.forename: Morris
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Hackensack University Medical Center, Hackensack, New Jersey;
authors.forename: Michael
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Betty H. Cameron Women's and Children's Hospital, Wilmington, North Carolina;
authors.forename: Sheri
authors.initials: S
authors.lastname: Carroll
authors.affiliation: Betty H. Cameron Women's and Children's Hospital, Wilmington, North Carolina;
authors.forename: Brandi
authors.initials: B
authors.lastname: Page
authors.affiliation: Department of Pediatrics, Oregon Health and Science University School of Medicine, Portland, Oregon;
authors.forename: Judith
authors.initials: J
authors.lastname: Guzman-Cottrill
authors.affiliation: Greenville Health System, Greenville, South Carolina;
authors.forename: M Whit
authors.initials: MW
authors.lastname: Walker
authors.affiliation: Wheaton Franciscan Healthcare-St Joseph, Milwaukee, Wisconsin; and.
authors.forename: Jeff
authors.initials: J
authors.lastname: Garland
authors.affiliation: Wheaton Franciscan Healthcare-St Joseph, Milwaukee, Wisconsin; and.
authors.forename: Janice K
authors.initials: JK
authors.lastname: Ancona
authors.affiliation: Pediatrix Medical Group, Des Moines, Iowa.
authors.forename: Dan L
authors.initials: DL
authors.lastname: Ellsbury
authors.affiliation: Department of Pediatrics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina;
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Laughon
authors.affiliation: Department of Pediatrics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; mjmcaff@email.unc.edu.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: McCaffrey
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D062905:Central Venous Catheters / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014481:United States