Abstract
BackgroundThe 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.MethodsWe 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).ResultsWe 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.ConclusionsOff-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.
Highlights
The potential relationship between intravascular catheter infections with their insertion during weekend or night-time remains an open issue
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
Infectious risk for off‐hours in Central venous catheter and short-term dialysis catheter (CVC) Among CVCs and after adjustment for well-known risk factors for intravascular catheter infection, we found a similar risk between off- and on-hours for major catheter-related infections (MCRI) (HR 0.91, 95% CI 0.61–1.37, p = 0.65), catheter-related bloodstream infection (CRBSI) (HR 1.05, 95% CI 0.65–1.68, p = 0.85) and catheter tip colonization (HR 1.04, 95% CI 0.90–1.21, p = 0.59, Fig. 2)
Summary
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. Patients admitted to hospital during off-hours (i.e., during the night or at weekend) may experience poorer quality of care and clinical outcomes due to the reduced human resources. The degree to which intravascular catheter infections were associated with weekend or night-time (i.e., off-hours) insertions reflects poorer quality of care remains an open issue. No study has investigated the variations in clinical processes and risk of intravascular catheter infections between on- compared with offhours insertions
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