Healthcare Infection Prevention

Noncuffed catheters linked to infections

CDC publishes first national data

Initial results from the first national project to monitor infections in patients undergoing hemodialysis indicate that vascular access infections were common and that risk varied substantially among different vascular access types and different dialysis centers, the Centers for Disease Control and Prevention (CDC) reported. "Rates of infections and other events were substantially higher in patients who underwent dialysis with the use of catheters, especially noncuffed catheters," CDC researchers reported.1

"Catheters are a portal of entry for infection and are probably used in patients with higher severity of illness (i.e., those who have required dialysis longer and for whom there are no other options for vascular access). The high infection rates associated with catheters are a concern because both the number of patients undergoing hemodialysis and the percentage of patients with dialysis catheters are increasing each year," they said.

The CDC created the voluntary system because hemodialysis patients have frequent infections, especially of the vascular access site, and often harbor antimicrobial-resistant pathogens. Indeed, many of the first cases of emerging vancomycin resistance in Staphylococcus aureus have been in dialysis patients.

Breaking down the data

From October 1999 to May 2001, participating centers recorded the number of chronic hemodialysis outpatients that were treated. Several outcome events, including infections of the vascular access site, were monitored. Data were reported on paper forms or via an Internet-based data entry and analysis system.

Among 109 participating centers, the vascular access infection rate per 100 patient-months was 3.2 overall and varied markedly by type of vascular access: 0.56 for native arteriovenous fistulas, 1.36 for synthetic arteriovenous grafts, 8.42 for cuffed catheters, and 11.98 for noncuffed catheters. Among 76 dialysis centers reporting at least 200 patient-months of data, 11 had a significantly low and 14 a significantly high rate of vascular access infection. By comparing practices at centers with high vs. low infection rates, the CDC hopes to develop new infection control strategies.

Dialysis centers wishing to enroll in or receive a protocol for this project may do so by visiting http://www.cdc.gov/ncidod/hip/Dialysis/dsn.htm.

Reference

1. Tokars JI, Miller E, Stein G. New national surveillance system for hemodialysis-associated infections: Initial results. Am J Infect Control 2002; 30:288-295.