Prevalence of the u s e of central venous access devices w i t h i n and outside of the intensive care unit: results of a survey among hospitals

OBJECTIVE: To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting. DESIGN: A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use. SETTING: Inpatient wards and ICUs of six large urban teaching hospitals. RESULTS: At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients. CONCLUSIONS: Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU (Infect Control Hosp Epidemiol 2003;24:942-945). Central venous catheters (CVCs) are essential in today's healthcare environment. CVCs are extremely prevalent in intensive care units (ICUs), with mean utilization rates ranging between 32% and 80% among adult ICU patients. CVC use has increased in frequency in ICU settings during the past decade with a concomitant rise in complications associated with such use. Bloodstream infections (BSIs) are the most serious complication of CVC use. Primary catheter-associated BSIs are the third leading cause of nosocomial infections and comprise 19% of all such infections.' Approximately 80% to 90% of all primary BSIs are catheter related and most are due to CVC use. Among different types of ICUs, the rates of catheter-associated BSIs reported to the National Nosocomial Infections Surveillance System range from 2.9 to 8.8 per 1,000 catheter-days. Risk factors for catheter-associated BSI include the duration of catheterization, type of catheter, number of lumens, type of infusate, insertion technique, site of insertion, site preparation, and certain host factors." The identification of these specific risk factors has led to various strategies to prevent catheter-associated BSI among ICU patients. Improvements in catheter insertion techniques and care, maximal barriers use during CVC insertion, and choice of catheter types have been employed among ICU patient populations with success. Because of the increasing acuity of the conditions of hospitalized patients, patients on the wards and not just in the ICU are increasingly requiring CVCs. However, little is known about the epidemiology of CVC use outside of ICUs. We therefore conducted a survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the Centers for Disease Control and Prevention (CDC). Drs. Climo and Wong are from the Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia. Drs. Diekema and Herwaldt are from the University of Iowa College of Medicine, Iowa City, Iowa. Drs. Warren and Fraser are from the Washington University School of Medicine, St. Louis, Missouri. Dr. Perl is from the Johns Hopkins Medical Institutions, Baltimore, Maryland. Dr. Peterson is from the Evanston Northwestern Healthcare Research Institute, Evanston, Illinois. Ms. Plaskett and Dr. Sepkowitz are from Memorial Sloan Kettering Hospital, New York, New York. Dr. Price is from the University of Colorado Health Sciences Center, Denver, Colorado. Drs. Solomon and Tokars are from the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Address reprint requests to Michael Climo, Hunter Holmes McGuire Veteran Affairs Medical Center, 1201 Broad Rock Blvd., Section 111-C, Richmond, VA 23249. Supported by Cooperative Agreement Award UR8CCU-315346-04 from the Centers for Disease Control and Prevention, Atlanta, Georgia. Vol. 24 No. 12 CVC USE WITHIN AND OUTSIDE OF THE ICU 943 TABLE 1 USE OF CENTRAL VENOUS CATHETERS WITHIN