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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 ([email protected]).
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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 

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