RISK-FACTORS FOR CENTRAL VENOUS CATHETER-RELATED INFECTIONS IN SURGICAL AND INTENSIVE-CARE UNITS

OBJECTIVE: To identify avoidable risk factors for central venous cathe ter (CVC) infections in patients undergoing short-term catheterization . DESIGN: Prospective multicenter cohort study. SETTING: Two universit y teaching hospitals and five large nonteaching hospitals. PATIENTS: P atients admitted to intensive care units or surgical units and exposed to short-term CVCs. RESULTS: Of 623 catheterization episodes, 9.3% we re associated with catheter-related infections (CRI). The skin at the catheter site was frequently colonized (16.2%) and was the potential s ource of infection in 56.1% of the cases, mostly local infections. The hub was colonized less frequently (3.5%) but was responsible for syst emic infections more frequently. The following variables were independ ently associated with CRI: duration of catheterization (for 7 to 14 da ys, odds ratio [OR], 3.9; 95% confidence interval [CI]95, 1.4 to 10.7; and for > 14 days, OR, 5.1; CI95, 1.7 to 15.4), coronary care unit se rvice (OR, 6.7; CI95, 1.1 to 42.9) or surgery service (OR, 4.4; CI95, 1.03 to 18.5), second episode of catheterization (OR, 7.6; CI95, 1.8 t o 32.3), skin colonization at the insertion site (OR, 56.5; CI95, 10.8 to 296), and hub colonization (OR, 17.9; CI95, 2.4 to 132). The risk associated with skin colonization varied with use of jugular access or simultaneous colonization of the hub. When only symptomatic CRI was c onsidered, the risk associated with hub colonization was consistently higher (OR, 36.6; CI95, 7 to 190) than that associated with skin colon ization (OR, 3.2; CI95, 0.7 to 14). Age, transparent dressing, jugular insertion, male gender, duration of catheterization, and hub coloniza tion were independent risk factors for skin colonization. The effect o f age varied by type of dressing and vice versa; the effect of jugular access varied by sex; and the effect of transparent dressing varied b y length of catheterization and vice versa. Total parenteral nutrition and skin colonization were independently associated with an increased risk of hub colonization. CONCLUSIONS. Skin and hub colonization are the two major determinants for endemic CRIs; colonization of the hub, however, is more frequently associated with more severe infections. In order to reduce CRIs, more efforts should be focused on understanding which,factors increase the risk of colonization both of the skin and of the hub (Infect Control Hosp Epidemiol 1994; 15:253-264).