Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
Hostname: page-component-ffbbcc459-gmk6f Total loading time: 0.181 Render date: 2022-03-05T15:51:50.643Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }
  • English
Infection Control & Hospital Epidemiology Infection Control & Hospital Epidemiology

Article contents

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis

Published online by Cambridge University Press:  23 January 2015

Yoona Rhee ,
Michael Heung ,
Benrong Chen  and
Carol E. Chenoweth
Yoona Rhee*
Affiliation:
University of Michigan Health System, Ann Arbor, Michigan Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
Michael Heung
Affiliation:
University of Michigan Health System, Ann Arbor, Michigan Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan Division of Nephrology, University of Michigan Health System, Ann Arbor, Michigan
Benrong Chen
Affiliation:
University of Michigan Health System, Ann Arbor, Michigan Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor, Michigan
Carol E. Chenoweth
Affiliation:
University of Michigan Health System, Ann Arbor, Michigan Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
*
Address correspondence to Yoona Rhee, MD, Rush University Medical Center, Section of Infectious Diseases, 600 South Paulina St., Suite 143, Chicago, IL 60612 (yoonarhee@hotmail.com).
Get access Rights & Permissions[Opens in a new window]

Abstract

OBJECTIVE

Little is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort.

DESIGN

Retrospective observational study from January 2010 to December 2011

SETTING

An 880-bed tertiary teaching hospital

PATIENTS

Patients with CLABSI in non–ICU wards

METHODS

CLABSI patients were identified from existing infection-control databases and primary chart review was conducted. National Health and Safety Network (NHSN) definitions were utilized for CLABSI and pathogen classification. CLABSI rates were calculated per patient day. Total mortality rates were inclusive of hospice patients.

RESULTS

Over a 2-year period, 104 patients incurred 113 CLABSIs for an infection rate of 0.35 per 1,000 patient days. The mean length of hospital stay prior to CLABSI was 16±13.3 days, which was nearly 3 times that of hospital-wide non-ICU length of stay. Only 11 patients (10.6%) received dialysis within 48 hours of CLABSI. However, 67% of patients had a hematologic malignancy, and 91.8% of those admitted with a malignant hematologic diagnosis were neutropenic at the time of CLABSI. Enterococcus spp. was the most common organism recovered, and half of all central venous catheters (CVCs) present were peripherally inserted central catheters (PICC lines). Mortality rates were 18.3% overall and 27.3% among dialysis patients.

CONCLUSIONS

In patients with CLABSIs outside of the ICU, only 10.6% received dialysis prior to infection. However, underlying hematologic malignancy, neutropenia, and PICC lines were highly prevalent in this population.

Infect Control Hosp Epidemiol 2015;00(0):1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 424 - 430
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. O’Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections, Centers for Disease Control and Prevention. MMWR 2002;51:1–29.Google ScholarPubMed
2. Centers for Disease Ccontrol and Prevention. Vital signs: central line-associated bloodstream infections—United States, 2001, 2008, and 2009. MMWR 2011;60:243–248.Google Scholar
3. Tedja, R, Gordon, SM, Fatica, C, Fraser, TG. The descriptive epidemiology of central line-associated bloodstream infection among patients in non-intensive care unit settings. Infect Control Hosp Epidemiol 2014;35:164–168.CrossRefGoogle ScholarPubMed
4. Kallen, AJ, Patel, PR, O’Grady, NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010;51:335–341.CrossRefGoogle 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;24:942–945.CrossRefGoogle Scholar
6. Marschall, J, Leone, C, Jones, M, Nihill, 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;28:905–909.CrossRefGoogle ScholarPubMed
7. Zingg, W, Sax, H, Inan, C, et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009;73:41–46.CrossRefGoogle ScholarPubMed
8. 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;71:117–122.CrossRefGoogle ScholarPubMed
9. Trick, WE, Vernon, MO, Welbel, SF, Wisniewski, MF, Jernigan, JA, Weinstein, RA. Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol 2004;25:266–268.CrossRefGoogle ScholarPubMed
10. U.S. Renal Data System, USRDS 2012 Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2012.Google Scholar
11. D'Agata, EM, Mount, DB, Thayer, V, Schaffner, W. Hospital-acquired infections among chronic hemodialysis patients. Am J Kidney Dis 2000;35:1083–1088.CrossRefGoogle ScholarPubMed
12. Al-Rawajfah, OM, Stetzer, F, Hewitt, JB. Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol 2009;30:1036–1044.CrossRefGoogle Scholar
13. Device Associated Module CLABSI. Centers for Disease Control and Prevention National Healthcare Safety Network website. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Published 2011, 2014. Accessed November 20, 2011 and March 14, 2014.Google Scholar
14. List of Medications Contraindicating Receipt of Smallpox Vaccine. Centers for Disease Control and Prevention website. http://www.bt.cdc.gov/agent/smallpox/vaccination/pdf/immuno-suppress-meds.pdf, Published 2003. Accessed February 5, 2012.Google Scholar
15. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286–300.CrossRefGoogle ScholarPubMed
16. 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.CrossRefGoogle ScholarPubMed
17. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol 2007;28:1361–1366.CrossRefGoogle ScholarPubMed
18. Kelly, MS, Conway, M, Wirth, KE, Potter-Bynoe, G, Billett, AL, Sandora, TJ. Microbiology and risk factors for central line-associated bloodstream infections among pediatric oncology outpatients: a single institution experience of 41 cases. J Pediatric Hematol Oncol 2013;35:e71–e76.CrossRefGoogle ScholarPubMed
19. Boersma, RS, Jie, KS, Verbon, A, van Pampus, EC, Schouten, HC. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Annal Oncol 2008;19:433–442.CrossRefGoogle ScholarPubMed
20. Mollee, P, Jones, M, Stackelroth, J, et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect 2011;78:26–30.CrossRefGoogle ScholarPubMed
21. Elishoov, H, Or, R, Strauss, N, Engelhard, D. Nosocomial colonization, septicemia, and Hickman/Broviac catheter-related infections in bone marrow transplant recipients. A 5-year prospective study. Medicine 1998;77:83–101.CrossRefGoogle Scholar
22. Carlisle, PS, Gucalp, R, Wiernik, PH. Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993;14:320–324.CrossRefGoogle ScholarPubMed
23. Dettenkofer, M, Ebner, W, Bertz, H, et al. Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant 2003;31:795–801.CrossRefGoogle Scholar
24. Tomlinson, D, Mermel, LA, Ethier, MC, Matlow, A, Gillmeister, B, Sung, L. Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis 2011;53:697–710.CrossRefGoogle ScholarPubMed
25. Steinberg, JP, Robichaux, C, Tejedor, SC, Reyes, MD, Jacob, JT. Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013;34:171–175.CrossRefGoogle ScholarPubMed
26. Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52:1446–1450.CrossRefGoogle ScholarPubMed
27. 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;33:865–868.CrossRefGoogle ScholarPubMed
28. Dutcher, K, Lederman, ER, Brodine, S, Patel, S. Impact of the 2013 revised Centers for Disease Control and Prevention central line-associated bloodstream infection (CLABSI) surveillance definition on inpatient hospital CLABSI rates: is it enough? Infect Control Hosp Epidemiol 2013;34:999–1001.CrossRefGoogle Scholar
29. Freeman, JT, Elinder-Camburn, A, McClymont, C, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013;34:89–92.CrossRefGoogle ScholarPubMed
30. Chopra, V, O’Horo, JC, Rogers, MA, Maki, DG, Safdar, N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908–918.CrossRefGoogle ScholarPubMed
31. Cheong, K, Perry, D, Karapetis, C, Koczwara, B. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours. Internal Med J 2004;34:234–238.CrossRefGoogle ScholarPubMed
32. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med 2006;355:2725–2732.CrossRefGoogle Scholar
33. Pronovost, PJ, Goeschel, CA, Colantuoni, E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.CrossRefGoogle ScholarPubMed
15
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *