Practices and intravascular catheter infection during on- and off-hours in critically ill patients

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Abstract

Background

The potential relationship between intravascular catheter infections with their insertion during weekend or night-time (i.e ., off-hours or not regular business hours) remains an open issue. Our primary aim was to describe differences between patients and catheters inserted during on- versus off-hours. Our secondary aim was to investigate whether insertions during off-hours influenced the intravascular catheter infectious risks.

Methods

We performed a post hoc analysis using the databases from four large randomized-controlled trials. Adult patients were recruited in French ICUs as soon as they required central venous catheters or peripheral arterial (AC) catheter insertion. Off-hours started at 6 P.M. until 8:30 A.M. during the week; at weekend, we defined off-hours from 1 P.M. on Saturday to 8.30 A.M. on Monday. We performed multivariable marginal Cox models to estimate the effect of off-hours ( versus on-hours) on major catheter-related infections (MCRI) and catheter-related bloodstream infections (CRBSIs).

Results

We included 7241 patients in 25 different ICUs, and 15,208 catheters, including 7226 and 7982 catheters inserted during off- and on-hours, respectively. Catheters inserted during off-hours were removed after 4 days (IQR 2, 9) in median, whereas catheters inserted during on-hours remained in place for 6 days (IQR 3,10; p < 0.01) in median. Femoral insertion was more frequent during off-hours. Among central venous catheters and after adjusting for well-known risk factors for intravascular catheter infection, we found a similar risk between off- and on-hours for MCRI (HR 0.91, 95% CI 0.61–1.37, p = 0.65) and CRBSI (HR 1.05, 95% CI 0.65–1.68, p = 0.85). Among central venous catheters with a dwell-time > 4 or > 6 days, we found a similar risk for MCRI and CRBSI between off- and on-hours. Similar results were observed for ACs.

Conclusions

Off-hours did not increase the risk of intravascular catheter infections compared to on-hours. Off-hours insertion is not a sufficient reason for early catheter removal, even if femoral route has been selected.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-021-00940-3.

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Most cited references 23

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Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system.

Eyal Zimlichman, Daniel Henderson, Orly Tamir … (2013)

Health care-associated infections (HAIs) account for a large proportion of the harms caused by health care and are associated with high costs. Better evaluation of the costs of these infections could help providers and payers to justify investing in prevention. To estimate costs associated with the most significant and targetable HAIs. For estimation of attributable costs, we conducted a systematic review of the literature using PubMed for the years 1986 through April 2013. For HAI incidence estimates, we used the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC). Studies performed outside the United States were excluded. Inclusion criteria included a robust method of comparison using a matched control group or an appropriate regression strategy, generalizable populations typical of inpatient wards and critical care units, methodologic consistency with CDC definitions, and soundness of handling economic outcomes. Three review cycles were completed, with the final iteration carried out from July 2011 to April 2013. Selected publications underwent a secondary review by the research team. Costs, inflated to 2012 US dollars. Using Monte Carlo simulation, we generated point estimates and 95% CIs for attributable costs and length of hospital stay. On a per-case basis, central line-associated bloodstream infections were found to be the most costly HAIs at $45,814 (95% CI, $30,919-$65,245), followed by ventilator-associated pneumonia at $40,144 (95% CI, $36,286-$44,220), surgical site infections at $20,785 (95% CI, $18,902-$22,667), Clostridium difficile infection at $11,285 (95% CI, $9118-$13,574), and catheter-associated urinary tract infections at $896 (95% CI, $603-$1189). The total annual costs for the 5 major infections were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line-associated bloodstream infections (18.9%), C difficile infections (15.4%), and catheter-associated urinary tract infections (<1%). While quality improvement initiatives have decreased HAI incidence and costs, much more remains to be done. As hospitals realize savings from prevention of these complications under payment reforms, they may be more likely to invest in such strategies.

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Naomi P O'Grady, Mary C. Alexander, Lillian Burns … (2011)

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Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study

David Montaigne, Xavier Marechal, Thomas Modine … (2018)

On-pump cardiac surgery provokes a predictable perioperative myocardial ischaemia-reperfusion injury which is associated with poor clinical outcomes. We determined the occurrence of time-of-the-day variation in perioperative myocardial injury in patients undergoing aortic valve replacement and its molecular mechanisms.

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Author and article information

Contributors

Niccolò Buetti:

ORCID: http://orcid.org/0000-0002-8096-1834

niccolo.buetti@gmail.com

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 29 October 2021

Publication date PMC-release: 29 October 2021

Publication date Collection: 2021

Volume: 11

Electronic Location Identifier: 153

Affiliations

[1 ]University of Paris, INSERM, IAME, 75006 Paris, France

[2 ]AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877 Paris Cedex, France

[3 ]GRID grid.411119.d, ISNI 0000 0000 8588 831X, Medical and Infectious Diseases Intensive Care Unit, , AP-HP, Bichat-Claude Bernard University Hospital, ; 46 rue Henri Huchard, 75877 Paris Cedex, France

[4 ]GRID grid.411163.0, ISNI 0000 0004 0639 4151, Medical ICU, Gabriel-Montpied University Hospital, ; Clermont-Ferrand, France

[5 ]GRID grid.411162.1, ISNI 0000 0000 9336 4276, Services des Urgences Adultes and SAMU 86, , Centre Hospitalier Universitaire de Poitiers, ; 86021 Poitiers, France

[6 ]GRID grid.11166.31, ISNI 0000 0001 2160 6368, Université de Poitiers, ; Poitiers, France

[7 ]GRID grid.7429.8, ISNI 0000000121866389, Inserm U1070, ; Poitiers, France

[8 ]GRID grid.150338.c, ISNI 0000 0001 0721 9812, Infection Control Program and WHO Collaborating Centre On Patient Safety, , University of Geneva Hospitals and Faculty of Medicine, ; Geneva, Switzerland

Author information

Niccolò Buetti http://orcid.org/0000-0002-8096-1834

Article

Publisher ID: 940

DOI: 10.1186/s13613-021-00940-3

PMC ID: 8556470

PubMed ID: 34714451

SO-VID: 45ce6556-2735-499d-8e88-5817c04625da

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 5 August 2021

Date accepted : 17 October 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001711, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung;

Award ID: P4P4PM_194449

Award Recipient : Niccolò Buetti

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: catheter,catheter-related bloodstream infection,bloodstream infection,icu,off-hours,on-hours

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: catheter, catheter-related bloodstream infection, bloodstream infection, icu, off-hours, on-hours

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Practices and intravascular catheter infection during on- and off-hours in critically ill patients

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Irish Journal of Paramedicine

Most cited references 23

Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system.

Guidelines for the prevention of intravascular catheter-related infections.

Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study

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Cited by 2

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