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The Descriptive Epidemiology of Central Line–Associated Bloodstream Infection among Patients in Non-Intensive Care Unit Settings

Published online by Cambridge University Press:  10 May 2016

Rudy Tedja ,
Steven M. Gordon ,
Cynthia Fatica  and
Thomas G. Fraser
Rudy Tedja
Affiliation:
Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
Steven M. Gordon
Affiliation:
Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
Cynthia Fatica
Affiliation:
Department of Infection Prevention, Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, Ohio
Thomas G. Fraser*
Affiliation:
Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio Department of Infection Prevention, Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, Ohio
*
9500 Euclid Avenue, Desk G21 Cleveland, OH 44195 ([email protected])
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Abstract

Objective.

To review and describe device utilization and central line-associated bloodstream (CLABSI) events among patients in a non-intensive care unit (ICU) setting and to examine the morbidity and mortality associated with these events.

Design.

One-year descriptive review.

Setting.

A single tertiary center with a 1,200-bed hospital and 209 adult ICU beds.

Patients.

Hospitalized patients identified as having a CLABSI event attributed to a non-ICU setting.

Methods.

The cohort was identified from a prospective infection prevention database. Charts and administrative data sets were reviewed to further characterize the patients. Device utilization ratios (DURs) and CLABSI rates were calculated using National Health and Safety Network (NHSN) CLABSI definitions. Need for ICU stay and crude mortality rates were recorded.

Results.

A total of 136 patients with 156 CLABSIs were identified, of whom 78 (57%) were being treated for a hematological malignancy (HM). The overall DUR was 0.27. A tunneled line was in place for 118 (76%) of the CLABSI events, and a peripherally inserted central catheter was in place for 32 (21%) of the CLABSI events. The non-ICU CLABSI rate was significantly higher than the concurrent ICU rate (2.1 CLABSIs per 1,000 catheter-days vs 1.5 CLABSIs per 1,000 catheter-days; P = .02). Hospital mortality was 23% in the affected group and was significantly higher in patients with HM.

Conclusions.

CLABSI rates over a 1-year period were higher in patients outside the ICU at our hospital and were associated with significant mortality.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 164 - 168
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166.Google Scholar
2. Cardo, D, Dennehy, PH, Halverson, P, et al. Moving toward elimination of healthcare-associated infections: a call to action. Infect Control Hosp Epidemiol 2010;31(11):1101–1105.Google Scholar
3. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
4. Pronovost, PJ, Berenholtz, SM, Goeschel, C, et al. Improving patient safety in intensive care units in Michigan. J Crit Care 2008; 23(2):207–221.Google Scholar
5. Climo, M, Diekema, D, Warren, DK, et al. 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. Infect Control Hosp Epidemiol 2003;24(12):942–945.Google Scholar
6. Marschall, J, Leone, C, Jones, M, Nihili, D, Fraser, VJ, Warren, DK. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol 2007;28(8):905–909.Google Scholar
7. Centers for Disease Control and Prevention. Central line-associated bloodstream infection (CLABSI) event. 2013. http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Accessed January 5, 2013.Google Scholar
8. Isaac, S, Iwamoto, M, Allen-Bridson, K, Horan, T, Magill, SS, Thompson, ND. Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition. Infect Control Hosp Epidemiol 2013;34:769–776.Google Scholar
9. Son, CH, Daniels, TL, Eagan, JA, et al. Central line-associated bloodstream infection surveillance outside the intensive care unit: a multicenter survey. Infect Control Hosp Epidemiol 2012; 33:869–874.Google Scholar
10. Pongruangporn, M, Ajenjo, C, Russo, AJ, McMullen, KM, Robinson, C, Williams, RC, Warren, DK. Patient and device specific risk factors for peripherally inserted central venous catheter-related bloodstream infections. Infect Control Hosp Epidemiol 2013;34:184–189.CrossRefGoogle ScholarPubMed
11. Shapey, IM, Foster, MA, Whitehouse, T, Jumaa, P, Bion, JF. Central venous catheter-related bloodstream infections: improving post-insertion catheter care. J Hosp Infect 2009;71(2):117–122.Google Scholar
12. Cobb, S, Bertin, M, Fatica, C, Oden, M, Gordon, S, Fraser, TG. Providing more than a number: information technology toolkit empowers caregivers in process improvement program. ID Week; San Diego, CA; October 2012. Abstract 920.Google Scholar
13. Chopra, V, Anand, S, Krein, SL, Chenoweth, C, Saint, S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012; 125(8):733–741.Google Scholar
14. Tejedor, SC, Tong, D, Stein, J, et al. Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter”. Infect Control Hosp Epidemiol 2012;33:50–57.CrossRefGoogle Scholar
15. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39(4 suppl 1):S1–S34.Google Scholar
16. Digiorgio, MJ, Fatica, C, Oden, M, et al. Development of a modified surveillance definition of central line-associated bloodstream infections for patients with hematologic malignancies. Infect Control Hosp Epidemiol 2012;33(9):865–868.Google Scholar