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A multicentre analysis of catheter-related infection based on a hierarchical model

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Abstract

Purpose

To decrease intensive care unit (ICU)-acquired catheter-related infections (CRI), it is essential that healthcare workers receive training and that quality improvement programmes are in place. The aim of our study was to evaluate risk factors for catheter colonisation and infection, focussing specifically on local care bundles.

Methods

Data were collected prospectively in 51 ICUs [7,188 patients, 8,626 central venous catheters (CVCs)] during two 6-month periods in 2007 and 2008, using a standardized questionnaire on catheter insertion, care and removal. Colonisation and CRI incidence were 6.1 and 2.2/1,000 CVC-days, respectively. A hierarchical mixed logistic model was used to identify risk factors for CRI and colonisation.

Results

Written CVC protocols were available in 46 (90 %) ICUs and were strictly followed in 38 ICUs. Factors significantly associated with CRI fell into three overall categories: (1) patient-related factors—immunosuppression [odds ratio (OR) 1.42, p = 0.02], medical diagnosis at admission (OR 1.64, p = 0.03) and trauma patient (OR 2.54, p < 0.001); (2) catheter-related factors—catheter rank (OR 1.7, p < 0.0001, non-subclavian catheter (OR 2.1, p < 0.001) and longer time with the catheter (p < 10−4); (3) centre-related factors—quantitative tip culture method (OR 2.55, p = 0.005) and alcohol-based povidone-iodine [OR 0.68, 95 % confidence interval (CI) 0.49–0.96] or alcohol-based chlorhexidine preparations (OR 0.69, 95 % CI 0.34–1.39) as compared to an aqueous povidone-iodine preparation (p < 0.001).

Conclusions

We identified several risk factors for CRI that are amenable to improvement (preference for the subclavian route and use of an antiseptic solution containing alcohol). However, several patient-related factors were also found, and the use of quantitative catheter culture methods increased culture sensitivity, thereby increasing the CRI rate. Case-mix issues and the culture method should be taken into account when assessing the risk of CRI across centres.

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Acknowledgments

The HAI National Early Warning, Investigation and Surveillance (RAISIN) Working Group is a partnership between the five regional infection control coordinating centres (CLIN), funded by the French Ministry of Health and the National Public Health Surveillance Institute (InVS). REA-RAISIN is a national ICU-acquired infection surveillance network, granted by the InVS. This study was supported by an unrestricted research Grant from Ethicon.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to J. F. Timsit.

Additional information

On behalf of the REA-RAISIN network Committee listed in the Appendix.

All participating hospitals and intensive care units are listed in the Appendix.

Appendix

Appendix

Members of the REA-RAISIN network committee are: P.E. Bollaert (Nancy), R. Gauzit (Paris), D. Gruson, G. Janvier (Bordeaux), T. Lavigne (Strasbourg), A. Lepape (Lyon), P.F. Perrigault (Montpellier), J.F. Timsit (Grenoble), D. Villers (Nantes), S. Boussat, S. Mariani (CClin Est, Nancy), P. Jarno, Nadine Garreau (CClin Ouest, Rennes), F. l’Heriteau, F. Daniel (CClin Paris-Nord, Paris), A. Savey, A. Machut, I. Russell (CClin Sud-Est, Lyon), A.G. Venier, E. Reyrreaud (CClin Sud-Ouest), B. Coignard (InVS, Paris).

Participating local (city) hospitals (in alphabetic order) and investigators of the sub-study were: GARRIGUES Bernard, MARDRUS Philippe (CHG du pays d’Aix, AIX EN PROVENCE); HAUSERMANN Marie Hélène (CH Henri Mondor, AURILLAC); ROYER Daniel, EDE Cyrille (Centre Hospitalier, AUXERRE); COURANT Pierre, MARTIN Régine (CHG Henri Duffaut, AVIGNON); GUERIN Anne-Marie, GUERIN Anne-Marie (CH, BEAUVAIS); SAMAIN Emmanuel, TALON Daniel (CHU, BESANCON); BELLE Evelyne, TALON Daniel (CHU, BESANCON); DHONNEUR Gilles, DURAND Isabelle (Hôpital Jean Verdier, BONDY); LANCON Jean-Pierre, HUMEAU Catherine (Infirmerie Protestante de Lyon, CALUIRE ET CUIRE); ZERR Bernard, DEMANGE Marie (CHG, CHAMBERY); JUST Bernard, (Centre Hospitalier, CHARLEVILLE MEZIERES); BULTEL Jean, PAIRE Marie-Claude (CH, DIGNE LES BAINS); FREYSZ Marc, MILESI-DEFRANCE Nadine (CHU, DIJON); LETELLIER Nicolas, NEVEU Christiane (CH Victor Josselin, DREUX); PAYEN Jean-Francois, DURAND Michel (CHU, GRENOBLE); KEMPF Jean, FRITSCH Hubert (Centre Hospitalier, HAGUENAU); CLAUD Bernard, GAILLARD Michel (CHG Emile Roux, LE PUY EN VELAY); PELERIN Remy, STRUILLOU Laurence (CH Bretagne Sud, LORIENT); GUERIN Claude, BAYLE Frédérique (HCL-Hôpital Croix Rousse, LYON); BAILLON Jean-Jacques, BER Charles Eric (HCL-Hôpital Edouard Herriot, LYON); VIALE Jean-Paul, DUPERRET Serge (HCL-Hôpital Croix Rousse, LYON); ALLAOUCHICHE Bernard, FLOCCARD Bernard (HCL-Hôpital Edouard Herriot, LYON); GUERIN Claude, LERAY Véronique (HCL-Hôpital Croix Rousse, LYON); PUIDUPIN Marc, LIONS Christophe (Hôpital d’Instruction des Armées Desgenettes, LYON); MANCHON Jacques, POMMIER Christian (CH Saint Joseph-Saint Luc, LYON); SEGHBOYAN Jean-Marie, BENICHOUGRANE Nadine (Fondation Hôpital Ambroise Paré, MARSEILLE; MOKART Djamel, BERGER Pierre (Institut J. Paoli-Calmettes, MARSEILLE); OUNIS Nadia ,TURCON Monique (Clinique Vert Coteau, MARSEILLE); MARTIN Claude Denis, WIRAMUS Sandrine (APHM-Hôpital Nord, MARSEILLE; COURTIN Patrick (CHG, MARTIGUES); NICOLA Walid, FOURNIER-HOOCK Régine (CH, MONTARGIS); MILLET Olivier, PONCET Annie (CHG, MONTELIMAR); CHAUSSET Robert (CHG, MONTLUCON); CAPDEVILA Xavier, CHARDON Patrick (CHU-Hôpital Lapeyronie, MONTPELLIER); JONQUET Olivier, CORNE Philippe (CHU-Gui De Chauliac, MONTPELLIER); PERRIGAULT Pierre-François, GENIEZ Chantal (CHU-Gui De Chauliac, MONTPELLIER); CAPRON Matthieu, CAPRON Matthieu (CH de Moulins-Yzeure, MOULINS); CHABOT François, KHEIR Ayman (CHU, NANCY); MEISTELMAN Claude, PERRIER Jean-François (CHU, NANCY); GERARD Alain, THIVILIER Carine (CHU, NANCY); MASSON Bruno, PIQUE Martine (CHG, NARBONNE); GAUZIT Rémy, CASETTA Anne (Hôtel Dieu, PARIS 04EME); RABBAT Antoine, CASETTA Anne (Hôtel Dieu, PARIS 04EME); LEON Alain, LEPOUSE Claire (CHU, REIMS); LEON Alain, SUINAT Jean-Louis (CHU, REIMS); BEURET Pascal, CARTON Marie-Josée (CHG, ROANNE); THIBAUT Freddy, HOFF Jerôme (CH, SAINT-NAZAIRE); CAGNIN Sylvie, CAGNIN Sylvie (Hôpitaux du Mont Blanc, SALLANCHES); MOFREDJ Ali (CHG, SALON DE PROVENCE); JUNGFER-BOUVIER Françoise, GUIGNABERT Catherine (Centre Hospitalier, SENS); JACQUES Luc (CH Intercommunal du Bassin de Thau, SETE); POTTECHER Thierry, LAUNOY Anne (Hôpitaux Universitaire, STRASBOURG); COMBE Christian (CHG, VILLEFRANCHE SUR SAONE).

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Timsit, J.F., L‘Hériteau, F., Lepape, A. et al. A multicentre analysis of catheter-related infection based on a hierarchical model. Intensive Care Med 38, 1662–1672 (2012). https://doi.org/10.1007/s00134-012-2645-6

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