Central venous catheter infection rates in an acute care hospital.

When questions arose in the spring of 1990 concerning central venous catheter infections at a 414-bed, midwestern hospital, it was found that no hospital-wide prospective study of this problem had ever been completed. A descriptive, prospective study was conducted over 6 months, from October 1990 to April 1991, to determine the rate of infection associated with short-term central venous catheters at the study hospital. Additional research questions sought to examine the influence of certain risk factors on central venous catheter infection rates. Observation of central venous catheter sites was done every other day. Distal catheter segments were cultured by the semi-quantitative roll-plate method and by broth culture. Blood cultures were drawn at the physicians' clinical discretion. Organisms were fully speciated when clinically indicated. The investigators examined 448 catheters in 209 patients. One hundred thirty-nine catheters were not cultured because of random human error or coroner's requirements. In the remaining 309 catheters in 158 patients, a total of 5 clinical line infections was found. The infection rates were 1.6% for catheters, 2.8 infections per 1000 catheter days, and 3.2% per patient. Correlation of infection with risk factors was not possible because of the small number of infections. The clinical line infection rates found in this study compare favorably with other rates reported in the literature. Although the presence of any exceptional problem with central line infections at the hospital was not supported by this study, the number of lines placed during the study emphasizes the importance of high-quality central venous catheter placement and maintenance technique throughout the institution.