Limiting the use of float nurses for patients in intensive care units (ICUs) can reduce the risk of bloodstream infections related to central venous catheters (CVCs), according to a new study. Using antimicrobial-impregnated CVCs to deliver total parenteral nutrition (TPN) and peripherally inserted central catheter (PICC) lines may also reduce risks.
Researchers monitored CVCs, nurse staffing, and patient-related variables for bloodstream infections related to CVCs in 4,535 adult patients at eight ICUs over 2 years. Among the 8,593 CVCs, they identified 240 bloodstream infections related to CVCs (2.8%).
Having a float nurse care for a patient for more than 60% of the days he had a CVC was associated with a higher risk of a bloodstream infection. Researchers defined a float nurse as any nurse who'd worked on the participating unit for less than 1 year. They attributed this finding to a lack of familiarity with the unit's policies and organization in caring for ICU patients with CVCs. They recommend:
* ICU-specific training for nurses not permanently assigned to the unit
* cohorting ICU staff to patients at high risk for bloodstream infections.
Patients were also at higher risk if they didn't receive antibiotics within the first 48 hours following CVC insertion and if they weren't arousable for 70% or more of the time the CVC was in place.
Central venous catheters impregnated with antimicrobials reduced the risk of CVC-associated bloodstream infection only when the CVC was used to administer TPN. In these cases, the infection risk was reduced by 66%.
Patients who had a PICC line were at a lower risk for developing a CVC-associated bloodstream infection compared with other types of CVC, including nontunneled and central hemodialysis catheters.
"Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units," Infection Control and Hospital Epidemiology, J. Alonso-Echanove, et al., December 2003.