Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients

A prospective cohort study was performed to evaluate the influence of cathe ter manipulations on catheter associated bloodstream infection (CABSI) in n eonates. Neonates admitted between 1 November 1993 and 31 October 1994 at t he neonatal intensive care unit of a university hospital were included in t he study. Seventeen episodes of CABSI occurred in 357 central catheters ove r a period of 3470 catheter-days, with a cumulative incidence of 4.7/100 ca theters and an incidence density of 4.9/1000 catheter-days. Patient- and ca theter-related risk factors independently associated with CABSI were: cathe ter hub colonization (odds ratio [OR] = 32.6, 95% confidence interval [95% CI] = 4.3-249), extremely low weight (< 1000 gram) at time of catheter inse rtion (OR=9.1, 95% CI=1.9-42.2). Catheter manupulations independently assoc iated with CABSI were disinfection of the catheter hub (OR=1.2, 95% CI=1.1- 1.3), blood sampling (OR=1.4, 95% CI=1.1-1.8), heparinization (OR=0.9, 95%, CI=0.8-1.0) and antisepsis of exit site (OR=0.9, 95% CI=0.8-1.0). This stu dy indicates that certain manipulations (e.g. blood sampling through the ce ntral line) and disconnection of the central venous catheter, which necessi tates disinfection of the catheter hub, increase the risk of CABSI, while o ther procedures (e.g. heparinization and exit site antisepsis), protect aga inst CABSI in neonates. (C) 2001 The Hospital Infection Society.