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Bloodstream Infections: A Look Outside the ICU – Part 2 of 2

Categories: BSIs, CLABSI, Dialysis, NHSN, Outpatient Care

Central Line Catheter

Central Line Catheter

- Alex Kallen, MD, MPH
Medical Epidemiologist
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.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. January 19, 2012 at 5:58 am ET  -   Carman Angton

    Excellent post. I was checking constantly this blog and I am impressed! Very helpful info specially the last part :) I care for such information a lot. I was seeking this particular info for a long time. Thank you and good luck.

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  2. April 14, 2011 at 11:49 am ET  -   Josefine Ridder

    Spot on

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  3. August 10, 2010 at 6:18 pm ET  -   Chris Cahill

    Having just spent 4 days in the hospital (under sedation) the IV connectors hooked up to me were like luer locks that fit together with a twisting motion. I had two such devices one primary for IV therapy and the other secondary for a PCA pump.

    On the day of surgery the nurse started the IV and out of the corner of my eye I saw blood running down the sheet onto the floor. The nurse was not gloved and the blood ran over her bare fingers. (She removed her glove after inserting the angiocath.)The angiocath was secured with tape and covered with a clean plastic material (? impregnated with chg) From pre-op and surgery (spinal) I was transferred to the nursing unit. The connectors for both lines had visible blood in them. On the day before discharge the PCA pump was discontinued. Again a nurse twisted the connectors until they separated. The nurse had a glove on one hand and as she disconnected the secondary PCA pump line blood ran over her fingers. There were other manipulations of the ports and the insertion site. Fortunately there was no adverse events secondary to the IV lines.

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  4. August 5, 2010 at 10:46 am ET  -   cna

    Great site. A lot of useful information here. I’m sending it to some friends!

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  5. July 29, 2010 at 11:22 pm ET  -   akne.2

    Great site, I haven’t noticed blogs.cdc.gov till now in my searches! Continiue the great work!

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  6. July 28, 2010 at 12:36 am ET  -   Michael E. Bailey

    Education on bundled lines and how to care and clean them is critical to reducing bloodstream infections from their use. And home health care needs to be involved in this effort. I had a friend who had a foot infection several years ago and they tried to treat it with continuous line injections over 6 weeks or more. We are both clients of a regional center in California and the regional centers have health departments that include nursing staff. Regional Center nurses came out once a day to check the line, add the medication, and see how things were going. But the infection kept getting worse and ended with part of my friend foot being amputated. Good training on use of the lines is critical and keeping it current and updated is just as important. Best wishes, Michael E. Bailey.

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  7. July 23, 2010 at 12:03 pm ET  -   cgreenwell

    Please consider more work on infections in home health settings. This is great work, but central lines are often seen in home health. Thanks.

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  8. July 23, 2010 at 9:30 am ET  -   Pam Johnson

    How exciting to see attention being drawn to this topic. I am a DNP student and have been investigating this topic for my implementation project. The problem I am having is that most of the hospitals don’t monitor their infection rates outside of the ICU. As a result, I am having trouble defining measures to evaluate the impact of my interventions. I will be staying tune for further developments.

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  9. July 23, 2010 at 1:58 am ET  -   COLLEEN STRAIT

    DEAR DR. KALLEN,

    I’M HAPPY FOR ALL THAT IS BEING DONE FOR PREVENTING THIS VICIOUS INFECTION. I AM STILL SUFFERING THE LOSS OF MY SON, WHO IS AN ONLY CHILD. HE WAS HELPING WITH THE REMOVAL OF DAMAGED ITEMS, FROM A STILL PARTIALLY FLOODED BASEMENT (IOWA FLOOD OF 2008), WHEN HE WAS CUT ON HIS CALF BY A RUSTY NAIL…SHORTLY AFTER, HE STARTED HAVING PROBLEMS WITH PNUEMONIA, EDEMA, SHORTNESS OF BREATH, (JUST TO NAME A FEW). THIS WENT ON FOR SEVERAL MONTHS. HE WAS GIVEN MANY Z-PAK ANTIBIOTICS, BUT THIS NEVER HELPED. HE ALSO WENT THROUGH MANY PRODECURES LIKE A COLNOSCOPY BECAUSE ON ONE OF THE ER VISITS, THEY FOUND BLOOD IN HIS STOOL. THEN JUST A COUPLE OF WEEKS LATER THE DRS PUT AN ICD IN HIM BECAUSE BLOOD WAS POOLING IN THE LOWER PART OF HIS HEART, HE HAD V-TACHED ONCE ON IS WAY TO THE HOSPITAL, BUT CAME OUT OF IT ON HIS OWN. HE WAS IN & OUT OF THE HOSPITAL CONSTANTLY AFTER THIS WAS DONE WITH ALL THE ABOVE SYMPTOMS PLUS A FEW MORE. (I’M SURE YOU KNOW THE SCENARIO). BY AUGUST 2009, THEY DID ANOTHER PROCEDURE, AN ERCP TO SEE IF HE HAD A GALDSTONE BLOCKING HIS BILE, HE DID NOT! THEY KEPT HAVING TO GIVE HIM POTTASIUM, MAGNESIUM & SODIUM BECAUSE HIS BODY WOULDN’T RETAIN IT. HE WAS EXTREMELY EDEMA, ALL THE WAY TO HIS TOES! HIS BODY WAS WEEPING BADLY BY JULY 2009, WHICH LED TO THE VASCULITUS OF THE SKIN & MRSA(YES, HE HAD THE HORIBLE SORES ALL OVER HIS LEGS WORKING UP TO THE REST OF HIS BODY)! HE ALSO HAD TO HAVE MANY PICC LINES PUT IN BECAUSE THEY COULDN’T DRAW BLOOD FROM HIS VEINS, THEY WERE COLLAPSING. HE WAS NEVER PUT IN THE ICU UNTIL THE MORNING HE PASSED, THEY RUSHED HIM DOWN THERE AS HE WAS PASSING!!!!!! THEY KEPT OVER LOOKING THE FACT THAT MY SON WAS SUFFERING FROM A SYTEM-WIDE RESPONSE TO A BACTERIAL INFECTION IN HIS BLOOD STREAM. HE PASSED ON SEPTEMBER 26, 2009. I BELIEVE THE ER DOCTORS OVER LOOKED THIS, BECAUSE HIS CARDIOLOGIST KEPT TELLING US THAT IT WASN’T HIS HEART, IT WAS THE BLOOD INFECTION, BUT THEY CAUGHT IT TOO LATE. THEY WERE GOING TO LET HIM GO HOME THE DAY BEFORE HE PASSED! I WOULDN’T LET THEM.
    THE REASON I AM TELLING YOU ALL THIS, IS BECAUSE I FEEL THAT THE HOSPITAL SHOULD BE INVESTIGATED FOR THE PROTOCOL OF THESE VICIOUS INFECTION. DO THEY DO THE PROPER TEST FOR FINDING THEM~ARE THEY PAYING ATTENTION TO THE MENTAL STATUS OF THE PATIENCE WITH THE POSSIBLE INFECTION, ETC?
    PLEASE FEEL FREE TO CONTACT ME AT MY EMAIL…I HAVE SO MUCH MORE TO TELL! I AM SOOO CONCERNED THAT THERE ARE TOO MANY THAT SUFFER HERE AT THIS HOSPITAL.

    BEST REGARDS,
    ONE VERY CONCERNED MOM,
    COLLEEN STRAIT

    P.S. EVEN HIS PICC LINE SITES WERE INFECTED!

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  10. July 22, 2010 at 2:58 pm ET  -   Paul Suits

    I agree that more education about line care “maintenance bundles” needs to go out to home health agencies, dialysis centers and families who live with these lines daily. We educate patients about line so they know if it is not handled properly but the real education needs to go to the outpatient health agencies regarding line care.

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  11. July 22, 2010 at 2:36 pm ET  -   dental hygienist

    Keep posting stuff like this i really like it

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  12. July 21, 2010 at 4:27 pm ET  -   Tweets that mention CDC - Blogs - Safe Healthcare - Bloodstream Infections: A Look Outside the ICU – Part 2 of 2 -- Topsy.com

    [...] This post was mentioned on Twitter by Barbara K. Webber, RWJF QualityEquality. RWJF QualityEquality said: Efforts to prevent bloodstream infections need to also look outside of the ICU. http://ht.ly/2eFh3 [...]

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