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General and Risk Management, Patient Safety (including: medication errors, quality control)
Analysis of infections associated with central vascular catheters used for parenteral nutrition administration
  1. C. Conde Garcia,
  2. R. Seisdedos Elcuaz,
  3. E. Jerez Fernandez,
  4. R. Ruiz Martin de la Torre,
  5. S. Canales Ugarte,
  6. T. Sanchez Casanueva
  1. 1Hospital de Alcazar, Pharmacy, Ciudad Real, Spain; 2Hospital General de Tomelloso, Pharmacy, Ciudad Real, Spain

Abstract

Background Catheter-related infections(CRI) are highly prevalent and often associated with fatal complications. One year ago, intensive care unit (ICU) of our Hospital implemented a ‘Zero Bacteremia Project.’

Purpose To determine the rate of CRI in hospitalised patients receiving parenteral nutrition (PN) and to determinate whether there is any relationship with the route of administration and place of insertion (hospital ward or operating room).

Materials and methods Prospective study conducted in a General Hospital during 13 months. All patients who received PN by central line were included, and The authors registered the Medical Department, insertion date, localisation (peripherally inserted central line, subclavian, jugular, femoral or implanted ports), the place of insertion and, in case of infection, the date and the causal agent.

Results 177 central vascular catheters (CVC) were registered in 159 patients, of whom 62% were inserted by the surgery department, 20% by ICU, 12% by internal medicine and 6% by other ones. 71% of the CVC were inserted in the operating room. Subclavian route was mainly used in surgery and digestive departments (62% and 67% respectively), while in internal medicine and ICU there were more jugular vein insertions (76% and 63%). A total of 42 CVC were removed for suspected infection (24%), with positive cultures in 22 of them (12% of total). There were no case of infection in ICU patients, while digestive department had the highest rate (37%) followed by surgery (12%) and internal medicine (11%), probably because CVC were inserted in patients that had been hospitalised longer. Mean time between catheter insertion and infection was 11 days. The genus found in 73% of the cases was Staphylococcus and the most frequent species were Staphylococcus epidermidis (38%) and Staphylococcus hominis (19%). In three cases, polymicrobial infection was found.

Conclusions There is no uniformity among departments in using jugular or subclavian route. It was necessary to remove a high percentage of CVC on suspicion of infection, but only half of them had positive cultures. Based on these results, the Hospital Infections Committee has agreed to extend the ‘Zero Bacteremia Project’ to other inpatient Units.

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