Incidence, risk factors and outcome of central venous catheters in medical intensive care unit, an institutional experience

Introduction: Nosocomial infections, even in this modern era of antibiotics, continue to remain an important and formidable consequence of hospitalization. Vascular access by use of intravenous (i.v.) catheters is an essential element of modern medical care, particularly in Medical intensive care units (MICU). Vascular catheters interrupt the protective barrier of the skin and enable microorganisms potentially to gain direct access to the bloodstream causing catheter related infections. Material and Methods: 200 consecutive adult patients on central venous catheter admitted in MICU at our institute constituted the study population and among them those who developed systemic signs and symptoms of infections after 48 hours of admission were included in the study. Risk factors of patients and barrier precautions used by healthcare workers were observed during study period. Relevant samples were collected from patients for processing. Results: Among study population ,47(23.5%) patients developed central line related local infection and 7 (3.5%) patients developed central line associated blood stream infection(CLABSI).Incidence of CLABSI was 4.55% per 1000 central line days. Barrier precautions played an important role. Alcoholic hand rub (p=0.049), soap handwash (p=0.021), mask (p=0.001) usage prevented the development of central line related infection. Risk factors observed in local catheter infections due to central line catheter were Diabetes mellitus (p=0.002), Ventilator (p=0.001), Immunocompromised condition (p=0.001) and end stage renal disease (p=0.031). Outcome was not significantly associated with local catheter infections (p >0.05) .Patients who developed systemic infection (n=7), all expired (100%) showing the increased risk of mortality in these patients. Conclusion: Central venous catheterizations have an increased risk of developing local and systemic catheter associated infections particularly with risk factors. Hand hygiene constitutes the mainstay of preventing infection.