Prospective cohort study of central venous catheters among internal medicine ward patients


      Central venous catheter (CVC) use is less well described for patients outside the intensive care unit. We evaluated CVCs and the associated bloodstream infection rate among patients admitted to the general medical service.


      We performed a prospective cohort study of patients who had a CVC on admission or inserted during their stay on the general medical service in a public teaching hospital, November 15, 2004, to March 31, 2005.


      We identified 106 CVCs, 52 were present on admission and 54 were inserted; there were 682 catheter-days. The primary bloodstream infection rate was 4.4 per 1000 catheter-days (95% CI: 0.9-13): highest for catheters inserted in the emergency department compared with those inserted on other units (24 vs 1.7 per 1000 catheter-days), P = .045. By multivariable analysis, inadequate dressings were more likely among patients with a body mass index ≥30 kg/m2, adjusted odds ratio, 3.4 (95% CI: 1.4-8.0).


      Many CVCs had previously been inserted in the emergency department or intensive care unit; therefore, strategies to reduce bloodstream infections that focus on ward insertion practices may not dramatically reduce bloodstream infection rates. Intervention strategies should target improved dressing care and consideration of early removal or replacement of catheters inserted in the emergency department.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McGee D.C.
        • Gould M.K.
        Preventing complications of central venous catheterization.
        N Engl J Med. 2003; 348: 1123-1133
        • Renaud B.
        • Brun-Buisson C.
        Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients.
        Am J Respir Crit Care Med. 2001; 163: 1584-1590
        • Pittet D.
        • Tarara D.
        • Wenzel R.P.
        Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality.
        JAMA. 1994; 271: 1598-1601
        • Merrer J.
        • De Jonghe B.
        • Golliot F.
        • Lefrant J.Y.
        • Raffy B.
        • Barre E.
        • et al.
        Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial.
        JAMA. 2001; 286: 700-707
        • Sherertz R.J.
        • Ely E.W.
        • Westbrook D.M.
        • Gledhill K.S.
        • Streed S.A.
        • Kiger B.
        • et al.
        Education of physicians-in-training can decrease the risk for vascular catheter infection.
        Ann Intern Med. 2000; 132: 641-648
        • Eggimann P.
        • Harbarth S.
        • Constantin M.N.
        • Touveneau S.
        • Chevrolet J.C.
        • Pittet D.
        Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care.
        Lancet. 2000; 355: 1864-1868
        • Coopersmith C.M.
        • Rebmann T.L.
        • Zack J.E.
        • Ward M.R.
        • Corcoran R.M.
        • Schallom M.E.
        • et al.
        Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit.
        Crit Care Med. 2002; 30: 59-64
        • Bijma R.
        • Girbes A.R.
        • Kleijer D.J.
        • Zwaveling J.H.
        Preventing central venous catheter-related infection in a surgical intensive-care unit.
        Infect Control Hosp Epidemiol. 1999; 20: 618-620
        • Warren D.K.
        • Zack J.E.
        • Mayfield J.L.
        • Chen A.
        • Prentice D.
        • Fraser V.J.
        • et al.
        The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU.
        Chest. 2004; 126: 1612-1618
        • Warren D.K.
        • Zack J.E.
        • Cox M.J.
        • Cohen M.M.
        • Fraser V.J.
        An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center.
        Crit Care Med. 2003; 31: 1959-1963
        • Richards M.J.
        • Edwards J.R.
        • Culver D.H.
        • Gaynes R.P.
        • the National Nosocomial Infections Surveillance System
        Nosocomial infections in combined medical-surgical intensive care units in the United States.
        Infect Control Hosp Epidemiol. 2000; 21: 510-515
        • Braun B.I.
        • Kritchevsky S.B.
        • Wong E.S.
        • Solomon S.L.
        • Steele L.
        • Richards C.L.
        • et al.
        Preventing central venous catheter-associated primary bloodstream infections: characteristics of practices among hospitals participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) study.
        Infect Control Hosp Epidemiol. 2003; 24: 926-935
        • Climo M.
        • Diekema D.
        • Warren D.K.
        • Herwaldt L.A.
        • Perl T.M.
        • Peterson L.
        • et al.
        Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention.
        Infect Control Hosp Epidemiol. 2003; 24: 942-945
        • Trick W.E.
        • Vernon M.O.
        • Welbel S.F.
        • Wisniewski M.F.
        • Jernigan J.A.
        • Weinstein R.A.
        Unnecessary use of central venous catheters: the need to look outside the intensive care unit.
        Infect Control Hosp Epidemiol. 2004; 25: 266-268
        • Garner J.S.
        • Jarvis W.R.
        • Emori T.G.
        • Horan T.C.
        • Hughes J.M.
        CDC definitions for nosocomial infections, 1988.
        Am J Infect Control. 1988; 16: 128-140
        • National Nosocomial Infections Surveillance System
        National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004.
        Am J Infect Control. 2004; 32: 470-485
        • O'Grady N.P.
        • Alexander M.
        • Dellinger E.P.
        • Gerberding J.L.
        • Maki D.G.
        • McCormick R.D.
        • et al.
        Guidelines for the prevention of intravascular catheter-related infections.
        MMWR. 2002; 1: 1-26
        • Mermel L.A.
        • McCormick R.D.
        • Springman S.R.
        • Maki D.G.
        The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping.
        Am J Med. 1991; 91: 197S-205S
        • Trick W.E.
        • Kioski C.M.
        • Howard K.M.
        • Cage G.D.
        • Tokars J.I.
        • Yen B.M.
        • et al.
        Outbreak of Pseudomonas aeruginosa ventriculitis among patients in a neurosurgical intensive care unit.
        Infect Control Hosp Epidemiol. 2000; 21: 204-208