Biomedical
How Should Surveillance Systems Account for Concurrent Intravascular Catheters?
Leonard A. Mermel
Peer Reviewed
Abstract
The risk of central venous catheter (CVC)-associated bloodstream infections has decreased dramatically.1 The same may not be true for infections associated with short-term peripheral venous catheters.2 The effects of future preventive efforts should be measured using data derived from evidence-based surveillance programs. Dube et al3 describe a multicenter, retrospective cohort study that assessed the risk of central line–associated bloodstream infection (CLABSI) associated with concurrent CVCs. Analyzing a propensity-adjusted cohort of 11 796 hospitalized patients by status of concurrent CVCs, the authors found that the likelihood of a patient developing CLABSI, after adjustment for confounders, was increased by 62% when they had 2 concurrent CVCs for more than two-thirds of their overall CVC dwell time. In a CVC survival analysis, the daily excess CLABSI risk associated with a concurrent CVC was approximately 80% after adjusting for confounders.
Key Questions and Answers
1. What is the effect of concurrent CVCs on CLABSI risk?
The risk of central line-associated bloodstream infections (CLABSI) increases by 62% when two concurrent central venous catheters (CVCs) are used for more than two-thirds of their overall dwell time.
2. Why should concurrent CVC days be included in surveillance?
Including concurrent CVC days in surveillance would provide a more accurate measure of CLABSI incidence and ensure equitable treatment of hospitals, particularly those with higher CVC use.
3. What are the potential unintended consequences of including concurrent CVCs in surveillance?
It could lower the threshold for maintaining catheters unnecessarily, potentially leading to increased use of CVCs when they may not be needed for patient care.
4. What other intravascular devices should be considered for infection risk?
Short-term peripheral venous catheters, which are increasingly used as a replacement for CVCs, may pose a greater risk of infection and should be included in future surveillance efforts.
