– Alex Kallen, MD, MPH
CDC’s Division of Healthcare Quality Promotion
You’ve probably seen some of the recent scientific and general news articles about bloodstream infections associated with central line and other catheters. Rates of central-line associated bloodstream infections (CLABSIs), barriers to prevention, mandated state and possible federal reporting of these infections and so on – the attention is important, as CLABSIs are a significant healthcare issue.
The Michigan Keystone Project and the Pittsburgh Regional Health Initiative have clearly shown that CLABSIs are preventable (at least in intensive care units [ICUs]), and have helped to fuel the rapid expansion of CLABSI prevention efforts around the country. These efforts include use of CLABSI prevention “bundles,” which primarily target central line insertion practices. In addition, many of these efforts promote an enhanced “culture of safety” that helps change the way healthcare personnel think about the preventability of these infections.
These efforts have resulted in significant decreases in CLABSIs in the ICU, as shown by Deron Burton and colleagues who evaluated ICU CLABSIs reported to CDC’s National Healthcare Safety Network (NHSN) from 1997 to 2007.
But what is happening outside the ICU?
Several reports have found that rates of CLABSIs outside the ICU are similar to those seen in the ICU, and since far more central lines are found outside the ICU than in, the overall burden of CLABSIs is probably greater outside the ICU.
Central lines are also commonly used in patients who receive most of their care as outpatients, including patients undergoing hemodialysis. According to the U.S. Renal Data System, rates of hospitalizations for infection among hemodialysis patients increased 34% from 1993 to 2006. CLABSIs were among the most common causes of these hospitalizations.
Outside the ICU, central lines are often in place for longer periods than those found in ICUs; in the case of hemodialysis patients, central lines may be in place for months. Therefore, although optimizing central line insertion practices remains important in these settings, working to maximize maintenance practices might also be an equally important part of prevention for these patients.
So, where do we go from here? Continuing the work in ICUs remains an important part of lowering rates of CLABSIs; however, expanding efforts to patients on hospital wards and outside the hospital is also important. However, more work will be needed to better understand the epidemiology of CLABSIs outside the ICU, particularly in outpatients, and to work to develop and implement maintenance interventions that can help decrease CLABSI rates in these settings.
See a new paper from Dr. Kallen further describing this topic.