Catheter-related infections in a medical cardio-pulmonary ICU: trends after the implementation of a nosocomial infection surveillance system (KISS)

Background

Central venous catheters are routinely used in critically ill patients and represent a source of nosocomial infections (NI). NI concern 5-15% of hospitalised patients and can lead to complications in 25-50% of those admitted to the ICU [1].

Methods

All patients with devices such as endotracheal tubes (ET), central venous lines (including pulmonary artery catheter) (CV) and/or urinary-tract catheters (UC) were prospectively enrolled during the first quarter of the years 1999 to 2001 according to a standardised protocol (KISS). Device-days, infections and infection rate were recorded. Data were analysed with regard to patients' severity of illness (SAPS II) and length of stay (LOS).

Results

Six hundred and twenty-seven patients with a mortality rate of 12.3% were enrolled in the study. The 31 patients (5%) who acquired a NI had significantly higher SAPS II score (42 ± 17 vs 31 ± 15, P < 0.001), hospital (33 ± 37 vs 13 ± 18, P < 0.001) and ICU LOS (18 ± 16 vs 4 ± 15, P < 0.001), proportion of ventilation (45% vs 12%, P < 0.001), and mortality (42% vs 11%, P < 0.001). NI occurred after 15 ± 11 days, median 14 days. Despite a significant decrease in device-days and ventilatory-days observed from 1999 to 2001, the absolute number of NI remained unchanged.

Conclusion

Patients at risk to acquire a NI in our ICU are obviously sicker. Whether increased LOS is due to the underlying disease or a result of the NI remains unclear. Implementation of a prospective surveillance protocol of NIs (KISS) led to a significant reduction in device-days and ventilatory-days, but did not reduce the absolute number of NIs. Thus, device-reduction appeared to be most effective in the less severely ill patients only.