ORIGINAL ARTICLE
Use of Central Venous Catheter-Related Bloodstream Infection Prevention Practices by US Hospitals

https://doi.org/10.4065/82.6.672Get rights and content

OBJECTIVE

To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs).

PARTICIPANTS AND METHODS

Between March 16, 2005, and August 1, 2005, a survey of infection control coordinators was conducted at a national random sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds (n=600) and at all Department of Veterans Affairs (VA) medical centers (n=119). Primary outcomes were regular use of 5 specific practices and a composite approach for preventing CR-BSIs.

RESULTS

The overall survey response rate was 72% (n=516). A higher percentage of VA compared to non-VA hospitals reported using maximal sterile barrier precautions (84% vs 71%; P=.01); chlorhexidine gluconate for insertion site antisepsis (91% vs 69%; P<.001); and a composite approach (62% vs 44%; P=.003) combining concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Those hospitals having a higher safety culture score, having a certified infection control professional, and participating in an infection prevention collaborative were more likely to use CR-BSI prevention practices.

CONCLUSION

Most US hospitals are using maximal sterile barrier precautions and chlorhexidine gluconate, 2 of the most strongly recommended practices to prevent CR-BSIs. However, fewer than half of non-VA US hospitals reported concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Wider use of CR-BSI prevention practices by hospitals could be encouraged by fostering a culture of safety, participating in infection prevention collaboratives, and promoting infection control professional certification.

Section snippets

Data Collection

Between March 16, 2005, and August 1, 2005, questionnaires were mailed to infection control coordinators at 719 hospitals across the United States.41 If the hospital employed more than 1 infection control professional (ICP), the one who supervised the other ICPs was asked to complete the survey. The 2005 American Hospital Association (AHA) database (fiscal year 2003 data) was used both to identify nonfederal, general medical, and surgical hospitals with more than 50 beds and with intensive care

RESULTS

The overall survey response rate was 72% (n=516), with 80% (n=95) of VA and 70% (n=421) of non-VA hospitals responding. Table 1 provides a comparison of the VA and non-VA hospitals across a number of characteristics. While the average number of ICU beds, evidence-based practice support score, use of hospitalists, and participation in an infection-related collaborative were similar for both, VA hospitals had a higher registered nurse staffing ratio, were more likely to be located in a

DISCUSSION

Evidence-based guidelines and recommendations have been published on how to reduce the risk of CR-BSIs, but often changes in practice lag behind guideline dissemination. In this case, however, our results suggest that a substantial proportion of US hospitals are following guideline recommendations and using 2 of the most strongly advocated practices: maximal sterile barrier precautions and chlorhexidine gluconate for insertion site antisepsis. Antimicrobial catheters are used by a smaller but

CONCLUSION

Our results have important implications for enhancing the safety of hospitalized patients.53, 54 Although many US acute care hospitals are following guidelines and using specific recommended practices for preventing CR-BSIs, fewer than half of non-VA US hospitals are concurrently using the 3 practices widely recommended to prevent CR-BSIs. To improve adoption of key CR-BSI prevention practices, hospitals can begin by fostering a culture of safety, encouraging ICP certification in infection

REFERENCES (54)

  • SL Krein et al.

    Translating infection prevention evidence into practice using quantitative and qualitative research

    Am J Infect Control

    (2006)
  • MJ Richards et al.

    Nosocomial infections in medical intensive care units in the United States

    Crit Care Med

    (1999)
  • National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1997: issued May 1997

    Am J Infect Control

    (1997)
  • RP Wenzel et al.

    The impact of hospital-acquired bloodstream infections

    Emerg Infect Dis

    (2001)
  • LA Mermel

    Prevention of intravascular catheter-related infections [published correction appears in Ann Intern Med. 2000;133:5]

    Ann Intern Med

    (2000)
  • RO Darouiche

    Device-associated infections: a macroproblem that starts with microadherence

    Clin Infect Dis

    (2001 Nov 1)
  • JL Vincent et al.

    The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study

    JAMA

    (1995)
  • S Saint et al.

    The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful?

    Infect Control Hosp Epidemiol

    (2000)
  • SI Blot et al.

    Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections

    Clin Infect Dis

    (2005 Dec 1)
  • D Pittet et al.

    Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality

    JAMA

    (1994)
  • B Digiovine et al.

    The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit

    Am J Respir Crit Care Med

    (1999)
  • S Saint

    Prevention of intravascular catheter-associated infections

  • NP O'Grady et al.

    Guidelines for the prevention of intravascular catheter-related infections

    MMWR Recomm Rep

    (2002)
  • II Raad et al.

    Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion

    Infect Control Hosp Epidemiol

    (1994)
  • N Chaiyakunapruk et al.

    Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine

    Clin Infect Dis

    (2003 Sep 15)
  • N Chaiyakunapruk et al.

    Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis

    Ann Intern Med

    (2002)
  • Cited by (95)

    • APIC Megasurvey 2020: Methodology and overview of results

      2023, American Journal of Infection Control
    • Value of certification in infection prevention and control

      2019, American Journal of Infection Control
    • Impact and Safety Associated with Accidental Dislodgement of Vascular Access Devices: A Survey of Professions, Settings, and Devices

      2018, JAVA - Journal of the Association for Vascular Access
      Citation Excerpt :

      A wealth of evidence-based guidelines from around the globe (eg, EPIC3 2014, CDC 2011, INS 2016, RCN 2017, RNAO 2008) direct the care of PIVs and CVADs to prevent complications and are used as comparators to evaluate the adoption of best practices.1,22-28 However, research indicates global inconsistencies in the application and use of the best practice recommendations.22,29-31 An Australian study of CVAD-related intensive care unit (ICU) practices revealed inconsistencies in frequency of use of stabilization devices, dressing replacement, and device management practices.31

    View all citing articles on Scopus

    This project was supported by the Department of Veterans Affairs, Health Services Research and Development Service (SAF 04-031) and the Ann Arbor VAMC/University of Michigan Patient Safety Enhancement Program. Dr Saint is supported by a VA Advanced Career Development Award.

    The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

    View full text