Infectious disease/CDC updateVital Signs: Central Line–Associated Blood Stream Infections—United States, 2001, 2008, and 2009
Introduction
Health care–associated infections (HAIs) account for a substantial portion of health care–acquired conditions1 that harm patients receiving medical care. Nearly 1 in every 20 hospitalized patients in the United States each year acquires an HAI. Central line–associated bloodstream infections (CLABSIs) are one of the most deadly types of HAIs, with a mortality rate of 12% to 25%.2 The Centers for Disease Control and Prevention (CDC) defines a CLABSI as recovery of a pathogen from a blood culture (a single blood culture for organisms not commonly present on the skin and 2 or more blood cultures for organisms commonly present on the skin) in a patient who had a central line at infection or within the 48-hour period before development of infection. The infection cannot be related to any other infection the patient might have and must not have been present or incubating when the patient was admitted to the facility.
In recent years, large-scale regional and statewide projects, such as the Pittsburgh Regional Healthcare Initiative and the Michigan Keystone Project, have demonstrated roughly 70% reductions in CLABSI rates in ICUs by increasing adherence to recommended best practices for the insertion of central lines.3, 4 Decreases in CLABSIs have been attributed to various factors, including increased financial and leadership support for CLABSI prevention, improved education and engagement of clinicians in prevention efforts, packaging of prevention recommendations into practice bundles, increased data monitoring and feedback on progress, improvement of the safety culture in health care, and local and statewide collaborative prevention efforts.
In 2009, the US Department of Health and Human Services set a national goal for a 50% reduction in CLABSIs by 2013.5 CDC monitors progress toward this goal through the National Healthcare Safety Network. This article describes progress in CLABSI reductions in ICUs and estimates the numbers of CLABSIs occurring in non-ICU settings. CDC estimated the number of CLABSIs among hospitalized patients aged 1 year or older in 2009 and among patients receiving outpatient hemodialysis in 2008. CDC also compared the number of CLABSIs in ICUs and the pathogens causing inpatient CLABSIs in 2001 and 2009.
Section snippets
Materials and Methods
For each setting (ICU, inpatient ward, and hemodialysis facility) and period, CDC multiplied patient-day estimates by central line use ratios to estimate the total number of central line–days nationally and then applied CLABSI rates to estimate the total number of infections. CDC estimated the total number of inpatient-days in US hospitals by averaging estimates from the Healthcare Cost and Utilization Project's National Inpatient Sample6 and the Hospital Cost Report Information System.7
Results
For the 2009 calculations, an estimated 168 million inpatient-days occurred in nonfederal acute care hospitals in the United States. After adding approximately 4.9% to account for patient-days in federal hospitals, CDC allocated 12.5% of days to ICUs and 87.5% to inpatient wards, yielding 22.1 million ICU-days and 154.3 million inpatient ward–days.
In 2001, the pooled mean central line use ratio in ICUs was 0.53 central line–days per patient-day, which yielded 11.7 million central line–days. The
Conclusions and Comment
In 2009, an estimated 25,000 fewer CLABSIs occurred among patients in ICUs in the United States than in 2001 (a 58% reduction). The cumulative number of CLABSIs prevented since 2001 is substantially higher because reductions have been occurring annually for the past decade.11 Given the reported mortality from CLABSIs, these reductions represent an estimated 3,000 to 6,000 lives saved and estimated excess health care costs of $414 million12 in ICUs in 2009 alone. Assuming that each CLABSI
References (17)
- et al.
Management of multidrug-resistant organisms in health care settings, 2006
Am J Infect Control
(2007) - et al.
Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients
Am J Kidney Dis
(2010) Hospital-Acquired Conditions
(2010)Guidelines for the prevention of intravascular catheter-related infections
MMWR Morb Mortal Wkly Rep
(2002)Reduction in central line–associated bloodstream infections among patients in intensive care units—Pennsylvania, April 2001–March 2005
MMWR Morb Mortal Wkly Rep
(2005)- et al.
An intervention to decrease catheter-related bloodstream infections in the ICU
N Engl J Med
(2006) National Action Plan to Reduce Healthcare-Associated Infections
(2010)- et al.
The healthcare cost and utilization project: an overview
Eff Clin Pract
(2002)
Cited by (33)
Interventions to reduce peripheral intravenous catheter failure: An international e-Delphi consensus on relevance and feasibility of implementation
2023, Journal of Infection and Public HealthAdherence to the central line bundle in intensive care: An integrative review
2021, American Journal of Infection ControlMicrobial colonization of intravascular catheter connectors in hospitalized patients
2019, American Journal of Infection Control
Editor's note: This article is part of a regular series on emerging infection from the Centers for Disease Control and Prevention (CDC) and the EMERGEncy ID NET, an emergency department–based and CDC-collaborative surveillance network. Important infectious disease public health information with relevance to emergency physicians is reported. The goal of this series is to advance knowledge about communicable diseases in emergency medicine and foster cooperation between the front line of clinical medicine and public health agencies.