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The Effect of Multiple Concurrent Central Venous Catheters on Central Line–Associated Bloodstream Infections

Published online by Cambridge University Press:  10 May 2016

Cathleen Concannon ,
Edwin van Wijngaarden ,
Vanessa Stevens  and
Ghinwa Dumyati
Cathleen Concannon
Affiliation:
Center for Community Health, University of Rochester Medical Center, Rochester, New York
Edwin van Wijngaarden
Affiliation:
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
Vanessa Stevens
Affiliation:
Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, Utah
Ghinwa Dumyati*
Affiliation:
Center for Community Health, University of Rochester Medical Center, Rochester, New York
*
Center for Community Health, 46 Prince Street Rochester, NY 14607 (cathleen_concannon@urmc.rochester.edu).
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Extract

Objective

The current central line–associated bloodstream infection (CLABSI) surveillance rate calculation does not account for multiple concurrent central venous catheters (CVCs). The presence of multiple CVCs creates more points of entry into the bloodstream, potentially increasing CLABSI risk. Multiple CVCs may be used in sicker patients, making it difficult to separate the relative contributions of multiple CVCs and comorbidities to CLABSI risk. We explored the relative impact of multiple CVCs, patient comorbidities, and disease severity on the risk of CLABSI.

Design

Case-control study.

Setting

A total of 197 case patients and 201 control subjects with a CVC inserted during hospitalization at a tertiary care academic medical center from January 1, 2008, to December 31, 2010.

Methods

Multiple CVCs was the exposure of interest; the primary outcome was CLABSI. Multivariable logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) describing the association between CLABSI and multiple CVCs with and without controlling for Acute Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index (CCI) scores as measures of disease severity and patient comorbidities, respectively.

Results

Patients with multiple CVCs (n = 78) showed a 4.2 (95% CI, 2.2–8.4) times greater risk of CLABSI compared with patients with 1 CVC after adjusting for CLABSI risk factors. When including APACHE II and CCI scores, multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4 [95% CI, 1.7–6.9]).

Conclusions

Multiple CVCs is an independent risk factor for CLABSI even after adjusting for severity of illness. Adjustment for this risk may be necessary to accurately compare rates between hospitals.

Infect Control Hosp Epidemiol 2014;35(9):1140-1146

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1140 - 1146
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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