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Catheter-Associated Bloodstream Infections in General Medical Patients Outside the Intensive Care Unit: A Surveillance Study

Published online by Cambridge University Press:  02 January 2015

Jonas Marschall ,
Carole Leone ,
Marilyn Jones ,
Deborah Nihill ,
Victoria J. Fraser  and
David K. Warren
Jonas Marschall
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Carole Leone
Affiliation:
BJC Healthcare, Saint Louis, Missouri
Marilyn Jones
Affiliation:
BJC Healthcare, Saint Louis, Missouri
Deborah Nihill
Affiliation:
BJC Healthcare, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri BJC Healthcare, Saint Louis, Missouri
David K. Warren*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri BJC Healthcare, Saint Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110 ([email protected])
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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).

Design.

Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003.

Setting.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 905 - 909
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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