Prevalence of the use of central venous access devices within and outside of the intensive care unit. Results of a survey among hospitals in the prevention epicenter program of the centers for disease control and prevention

OBJECTIVE: To determine the prevalence of central venous (CVC) use among patients both within and outside the ICU setting. DESIGN: A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use. SETTING: Inpatient wards and ICUs of six large urban teaching hospitals. RESULTS: At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55916) or jugular (22%) site, with femoral (6%) and peripheral (15916) sites less commonly used. The jugular (33.0% vs 16.6%; P <.001) and femoral (13.8% vs 2.7%; P <.001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P <.001) and subclavian (60.7% vs 47.3%; P <.001) catheters were more commonly used in non-ICU patients. CONCLUSIONS: Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.