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Healthcare Infection Healthcare Infection Society
Official Journal of the Australasian College for Infection Prevention and Control
EDITORIAL

Central line-associated bloodstream infection (CLABSI) rates: achieving the elusive goal of zero

Mary-Louise McLaws A C and William R. Jarvis B
+ Author Affiliations
- Author Affiliations

A School of Public Health and Community Medicine, UNSW, Sydney, NSW 2052, Australia.

B Jason and Jarvis Associates, LLC, 135 Dune Lane, Hilton Head Island, SC 29928, USA.

C Corresponding author. Email: m.mclaws@unsw.edu.au

Healthcare Infection 19(2) 39-41 https://doi.org/10.1071/HI14002
Submitted: 6 January 2014  Accepted: 13 January 2014   Published: 11 February 2014

Abstract

Zero-risk for CLABSI is achievable – but not without applying distinctively different strategies. Currently, the majority of ICU patients have a short dwell time, <9 days, and with aseptic insertion will remain infection-free for their entire ICU stay. But the minority of patients have a longer dwell time, contribute the majority of CLABSI and require more than aseptic insertion to reduce the risk of infection. Consequently, aggregating short and longer dwell times prevents us from evaluating care.


References

[1]  CDC Vital Signs: Central line – associated blood stream infections – United States, 2001, 2008, and 2009. MMWR Wkly Rep 2011; 60 243–8.

[2]  Cardo D, Dennehy PH, Halverson P, Fishman N, Kohn M, Murphy CL, et al Moving toward elimination of healthcare-associated infections: A call to action. Am J Infect Control 2010; 38 671–5.
Moving toward elimination of healthcare-associated infections: A call to action.Crossref | GoogleScholarGoogle Scholar | 21058460PubMed |

[3]  Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski JH, Berenholtz SM, et al Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010; 340 c309
Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study.Crossref | GoogleScholarGoogle Scholar | 20133365PubMed |

[4]  Burrell AR, McLaws ML, Pantle A, Murgo M, Herkes R. Aseptic insertion of central lines to reduce bacteraemia. Med J Aust 2011; 194 583–7.
| 21644871PubMed |

[5]  Bion J, Richardson A, Hibbert P, Beer J, McCutcheon M, Cassidy J, et al The Matching Michigan Collaboration and Writing Committee. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter- blood stream infections in intensive care units in England. BMJ Qual Saf 2013; 22 110–23.
The Matching Michigan Collaboration and Writing Committee. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter- blood stream infections in intensive care units in England.Crossref | GoogleScholarGoogle Scholar | 22996571PubMed |

[6]  Maki DG, Ash SR, Winger RK, Lavin P. A novel antimicrobial and antithrombotic lock solution for hemodialysis catheters: A multi-center, controlled, randomized trial. Crit Care Med 2011; 39 613–20.
A novel antimicrobial and antithrombotic lock solution for hemodialysis catheters: A multi-center, controlled, randomized trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXjsVyrsrs%3D&md5=f2514485728bd91a32b825fc58b0a305CAS | 21200319PubMed |

[7]  Hockenhull JC, Dwan KM, Smith GW, Gamble CL, Boland A, Walley TJ, et al The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections: a systematic review. Crit Care Med 2009; 37 702–12.
The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections: a systematic review.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXjs1KmsLc%3D&md5=34bc8472062359820450cbee7d72cd87CAS | 19114884PubMed |

[8]  Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49 1–45.
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXovVCnsro%3D&md5=1c5134e612ba4500440ed520a84533c1CAS | 19489710PubMed |

[9]  Barnett AG, Page K, Campbell M, Martin E, Rashleigh-Rolls R, Halton K, et al The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case–control study. BMJ Open 2013; 3 e003587
The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case–control study.Crossref | GoogleScholarGoogle Scholar | 24176795PubMed |

[10]  Rechner IJ, Lipman J. The costs of caring for patients in a tertiary referral Australian Intensive Care Unit. Anaesth Intensive Care 2005; 33 477–82.
| 1:STN:280:DC%2BD2Mvlt1Kisg%3D%3D&md5=f501e464cc995d952ab10c5fd96b46e8CAS | 16119489PubMed |

[11]  Moran JL, Peisach AR, Solomon PJ, Martin J. Cost calculation and prediction in adult intensive care: a ground-up utilization study. Anaesth Intensive Care 2004; 32 787–97.
| 1:STN:280:DC%2BD2M%2Fit1KrsQ%3D%3D&md5=996eec26bb224c70b23273e6d5bee14dCAS | 15648989PubMed |

[12]  Harnage S. Seven years of zero central-line-associated bloodstream infections. Br J Nurs 2012; 21: S6, S8, S10–2.

[13]  McLaws ML, Burrell A. Zero risk for central-line-associated bloodstream infection: are we there yet? Crit Care Med 2012; 40 388–93.
Zero risk for central-line-associated bloodstream infection: are we there yet?Crossref | GoogleScholarGoogle Scholar | 22020239PubMed |

[14]  McLaws ML, Berry G. Nonuniform risk for bloodstream infection with increasing central venous catheter-days. Infect Control Hosp Epidemiol 2005; 26 715–9.
Nonuniform risk for bloodstream infection with increasing central venous catheter-days.Crossref | GoogleScholarGoogle Scholar | 16156329PubMed |

[15]  Garland JS, Alex CP, Sevallius JM, Murphy DM, Good MJ, Volberding AM, et al Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. Infect Control Hosp Epidemiol 2008; 29 243–9.
Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters.Crossref | GoogleScholarGoogle Scholar | 18220483PubMed |

[16]  Ye X, Rupnow M, Bastide P, Lafuma A, Ovington L, Jarvis WR. Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States. Am J Infect Control 2011; 39 647–54.
Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States.Crossref | GoogleScholarGoogle Scholar | 21641681PubMed |

[17]  Chernecky CC, Macklin D, Jarvis WR, Joshua TV. Comparison of central line-associated bloodstream infection rates when changing to a zero fluid displacement intravenous needleless connector in acute care settings. Am J Infect Control in press.
Comparison of central line-associated bloodstream infection rates when changing to a zero fluid displacement intravenous needleless connector in acute care settings.Crossref | GoogleScholarGoogle Scholar |

[18]  Climo MW, Yokoe DS, Warren DK, Perl TM, Bolon M, Herwaldt LA, et al Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013; 368 533–42.
Effect of daily chlorhexidine bathing on hospital-acquired infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXitFelt78%3D&md5=98018efd13e286c22b3b462b15154ca2CAS | 23388005PubMed |

[19]  Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollack DA, Horan TC. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008; 36 609–26.
National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008.Crossref | GoogleScholarGoogle Scholar | 18992647PubMed |