Peripherally inserted central catheter (PICC) bloodstream infection surveillance rates in medical intensive care, medical-surgical wards, extended care, and outpatients

BACKGROUND/OBJECTIVES: There are limited benchmark data for bloodstream infections (BSIs) associated with peripherally inserted central catheters (PICCs). The benchmark for infection rates is the National Nosocomial Infections Surveillance (NNIS) data for intensive care units (ICUs). NNIS reports BSI rates per 1000 central line days for ICU patients. The NNIS BSI data includes PICC days plus other central line days in the ICUs. The objective of this prospective surveillance was to establish internal and comparative external benchmarks for PICC–associated BSI for the medical ICU (MICU), medical-surgical wards, the extended care unit, and outpatient care for a university-affiliated healthcare system. METHODS: Dedicated and trained intravenous therapy (IV) team members had the primary responsibility for PICC line insertion. IV team maintenance was every day for inpatients and weekly for outpatients. The IV team and infection control were responsible for prospective BSI case finding. Data on all positive blood cultures were reviewed. Infection rates were calculated from 1/1/03 through 6/30/04 for the MICU and through 12/31/04 for other patients. NNIS definitions of BSI were used for PICC and other central catheter infections. RESULTS: There were over 50,000 PICC days of prospective surveillance. The BSI rate for 1000 PICC days was calculated for units with at least 2500 PICC days. The MICU BSI rate was 0.33/1000 PICC days compared to the NNIS fifty-percentile rate for MICUs of 3.9 for all central catheters. The PICC BSI rates for the other populations were as follows: medical-surgical wards, 1.15/1000; extended care unit, 0.40/1000; and outpatient, 0.14/1000 days. Rates were not adjusted for patient severity of illness. CONCLUSIONS: Using the NNIS benchmark of 3.9 BSI/1000 central line days in MICUs, the MICU BSI infection rate was 11.8 times lower for PICC lines. There is no NNIS benchmark for medical-surgical wards, extended care units, or outpatients with PICC lines. With the increasing use of PICC lines and the opportunity to decrease central line infections, PICC BSI rates for all ICUs, inpatients, and outpatient areas should be considered for inclusion within the NNIS benchmark rates.