Dr LO Ho Yin, Angus (Resident Specialist, Department of Medicine), Pamela Youde Nethersole Eastern Hospital, Hong Kong, May 2008
Background: Catheter-related infections have significant impact on patient morbidity and mortality according to international research. However, local data in this area is lacking.
Method: An Insertion/baseline survey and a Follow-up/outcome survey were performed in the ICU of PYNEH. All patients admitted from 1st September 2006 to 31st December 2006 were assessed. Those with CVC inserted before or after admission were included. They were followed daily until CVC removal or 2 days after ICU discharge to derive the numerator data of catheter-related infections. Denominator data were derived daily from the unit.
Results: 112 patients were studied with 148 CVC inserted. Their mean age was 67 +/- 16 with a Male to Females ratio of 1.55: 1. Total 1102 catheter–days were generated with average time in situ of 7.5 days. Total patient-days were 2143 and the device utilization ratio was 0.51. Catheter colonization rate was 10.89 per 1000 catheter-days or 8.11%. Exit site infection rate was 4.54 per 1000 catheter-days or 3.38%. CABSI rate was 4.54 per 1000 catheter days or 3.38%. CRBSI rate was 0.91 per 1000 catheter-days or 0.68%. The CABSI rate was comparable with US benchmark of 2.2 per 1000 catheter-days (p=0.09) though above the 90 percentile of US data. Femoral insertion was associated with the highest rate of catheter colonization while jugular insertion was associated with the lowest. Using Cox-regression analysis, the following five factors were independently associated with catheter colonization: lower patient age (HR 0.895, 95%CI 0.841 – 0.953, p = 0.001), higher pulse rate (HR 1.048, 95%CI 1.012 to 1.085, p = 0.008), higher INR (HR 2.131, 95% CI 1.177 – 3.858, p = 0.013), higher haemstix level (HR 1.338, 95% CI 1.083 – 1.652, p = 0.07) at the time of CVC insertion and difficulty during CVC insertion (HR 6.794, 95% CI 1.316 – 35.081 p = 0.022).
Conclusion: The local CABSI rate was comparable to US benchmark but in the range of high outlier. Differences in risk factors of catheter colonization when compared with international literature might reflect ethnic differences or differences in practice. The study led by the COC ICU, which is being conducted in all HK hospitals, is important and highly relevant to assess the local situation and to further look for ways to improve on our strategies to prevent CABSI.
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