Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019

Abstract

The use of vascular devices in hospitalised patients is essential for their treatment, which frequently involves the administration of drugs and fluids, parenteral nutrition, or haemodialysis. The prevalence of peripheral (PVC) and central (CVC) venous catheter use among hospitalised patients estimated in different European surveys in the last decade is around 70% and 10% respectively [1-3]. In in a prospective cohort study published in 2010, catheter-related bloodstream infections (CRBSI) were the most important complications reported from 15 Spanish hospitals, with 821 bloodstream infections (BSI) episodes, representing almost 25% of all nosocomial BSI [4]. According to a paper from 2006 reporting a systematic review of 200 published prospective studies, the incidence rate of CRBSI per 1,000 catheter days generally ranges from 0.1 episodes for PVC to 2.7 episodes for CVC. CRBSI are an important cause of morbidity and mortality. Patients with these infections usually have more severe underlying illness and are more likely to have other healthcare-associated infections (HAI) during their admission, with a mortality ranging from 12% to 25%, according to a prospective nationwide surveillance study in the United States (US) from March 1995 through September 2002 [6]. CRBSI are also associated with longer hospital admissions and higher economic costs. The application of prevention programmes in intensive care units (ICU) in recent decades has resulted in significant reductions of CRBSI incidence rates [8]. Bundles of preventive measures have been applied including hand hygiene, use of chlorhexidine alcohol solution for skin antisepsis, full barrier precautions, daily review of need for catheterisation and femoral site avoidance. The Infection Control Catalan Programme (VINCat) was launched in 2006, with the main objective of reducing the incidence of HAI through continuous active monitoring and implementation of preventive programmes. Surveillance of CRBSI at the hospitals in our region is a priority [9]. The aim of this study is to describe the changes in the incidence and epidemiology of CRBSI in the hospitals participating in the VINCat programme over a 13-year period.