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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Incidence of central venous catheter hub contamination
Julie L Holroyd1, Terrie Vasilopoulos2, Mark J Rice3
1University of Florida College of Medicine, Gainesville, FL, USA.
Purpose:
To investigate microorganisms causing central venous catheter contamination and how this contamination differs across different catheter metrics.
Materials And Methods:
After obtaining IRB approval and informed consent, 830 cultures were prospectively obtained from 45 ICU patients with central venous catheter or peripherally inserted central catheter. Bacterial colonies were identified by mass spectrometry.
Results:
Bacterial contamination of central catheter hubs occurred 44% of the time in this study in the ICU setting. Coagulase-positive staphylococci cultures had higher median (±interquartile range) CFUs (12±232) versus coagulase-negative (3±10) and other bacteria (1±3; P<0.001). Bacterial contamination was associated with various metrics. Higher incidence (P<0.05) of coagulase-positive staphylococci cultures was associated with hub-only connections (a "hub" being a female connection; 10.9% vs. 7.9% male connections), connections without a manifold (1lumen device that mixes multiple infusions together; 9.7% vs. 0% with manifold); and central venous pressure monitoring connections (25.8% vs. 7.1% without). Internal jugular sites (10.0% vs. 2.7% femoral, 6.2% PICC, P=0.031) and medial lumens of triple lumen catheters (11.9% vs. 5.6% distal, 7.0% proximal, P=0.049) had increased incidence of higher bacteria loads (>15 CFUs).
Conclusions:
This study found a high incidence of central access catheter hub bacterial contamination, which correlated with positive blood cultures in 2 of 3 total bacteremia cases identified in the 45 patients.
Insights
Central venous catheter hubs frequently experience bacterial contamination, particularly with coagulase-positive staphylococci. This contamination is linked to specific catheter types and insertion sites, impacting patient safety.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Critical Care Medicine
Background:
- Central venous catheters (CVCs) are essential for critical care but pose infection risks.
- Catheter-related bloodstream infections (CRBSIs) are a significant source of morbidity and mortality in intensive care units (ICUs).
- Understanding the microbial landscape and contamination patterns on CVCs is crucial for effective prevention strategies.
Purpose of the Study:
- To identify the microorganisms responsible for central venous catheter contamination.
- To analyze how catheter contamination varies based on different catheter metrics and insertion sites.
- To assess the clinical implications of catheter hub contamination.
Main Methods:
- Prospective collection of 830 cultures from 45 ICU patients with CVCs or peripherally inserted central catheters (PICCs).
- Identification of bacterial colonies using mass spectrometry.
- Correlation of bacterial contamination with catheter characteristics, insertion sites, and patient outcomes.
Main Results:
- Bacterial contamination of central catheter hubs occurred in 44% of cases in the ICU.
- Coagulase-positive staphylococci showed significantly higher colony counts compared to other bacteria.
- Contamination was associated with hub-only connections, absence of a manifold, CVC monitoring connections, internal jugular insertion sites, and medial lumens of triple lumen catheters.
Conclusions:
- High incidence of bacterial contamination at central access catheter hubs was observed.
- Catheter hub contamination correlated with positive blood cultures, indicating a potential link to bacteremia.
- Findings highlight specific CVC configurations and sites associated with increased contamination risk, informing targeted interventions.
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