CENTRAL VENOUS CATHETERS - PROSPECTIVE SU RVEILLANCE IN ALL UNITS AT THE SAINT-ANTOINE HOSPITAL IN PARIS

OBJECTIVES: All the central Venous catheters (CVC) inserted at the Sai nt-Antoine Hospital between December 5, 1994 and June 6, 1995 were pro spectively studied in order to better define practises in the manageme nt of CVC and to determine the rate of catheter-related infections. ME THODS: The following data were recorded for each CVC : insertion proce dure, clinical data, catheter dressings, removal, catheter related inf ections, bacteriological findings. Catheter-related infections were di stinguished from probably catheter-related infections and localized sk in infections. RESULTS: Among 325 patients, a total of 414 catheters w ere inserted. At the end of the surveillance period, 350 (85 %) had be en removed, 43 (10 %) were still in place and 21 (5 %) were lost to fo llow-up. Analysis of procedures such as cutaneous disinfection, routin e replacement of the iv sets or changes of dressings showed wide Varia tions between care units and within the same unit The overall incidenc e of catheter-related infections was 0.24 per 100 days of catheterizat ion. Infections occurred 29 +/- 34 days after insertion. Microorganism s responsible for catheter-related bacteremia were mostly cram positiv e (84 %) and Gram negative (16 %). sixty-two infections(15 %) were cli nically suspected by physicians, leading to the catheter removal in 84 % of cases. Out of the 43 CVC sent to the laboratory, 29 (67 %) were negative (i.e. << sterile >>) in quantitative culture of the tips as d escribed by Brun-Buisson, suggesting that the CVC was unnecessarily re moved. Bacteriological analysis ordered by physicians were not always relevant For example, 76 % of CVC received by the laboratory were syst ematically sent although they were not suspected of infections. Conver sely, only 61 % of exsudate formation at the insertion site were colle cted and analyzed. CONCLUSION: This study was designed to recall good guide lines to the hospital staff Results will lead to the development of a better use of antiseptics and to the implementation of appropria te and standardized procedures to reduce risk infection. (C) 1997, Mas son, Paris.