452 Declining Rates of Central Line Associated Bloodstream Infections Secondary to Staphylococcal Species over 12 Years: Experience at an Urban Tertiary Care Center

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Michael Stevens, MD , Virginia Commonwealth University Medical Center, Richmond, VA
Gonzalo Bearman, MD, MPH , Virginia Commonwealth University Medical Center, Richmond, VA
Janis Ober, BSN , Virginia Commonwealth University Medical Center, Richmond, VA
Michael Edmond, MD, MPH, MPA , Virginia Commonwealth University Medical Center, Richmond, VA
Background: In recent years hospitals have implemented a host of interventions aimed at reducing the rate of central line associated bloodstream infections (CLABSI). Many of these interventions target pathogens that are skin flora. 
Objective: To describe the changes in CLABSI rates secondary to coagulase negative staphylococci (CNS) as well as Staphylococcus aureus over the past 12 years in an academic medical center.
Methods: Concurrent surveillance for CLABSI was conducted in 3 adult ICUs (a 16-bed medical ICU, 18-bed surgical ICU, and a 14-bed neuroscience ICU) of an 820-bed, urban, academic medical center beginning in 1998. The CDC CLABSI definition was utilized for surveillance. Multiple interventions to reduce CLABSI began in 2004 and were sequentially added over time. These included a hand hygiene campaign, feedback to specific ICUs on healthcare associated infections and practices with quarterly posters, adoption of the central line insertion bundle and chlorhexidine bathing of ICU patients. Comparisons in CLABSI rates were made for the following time periods: pre-intervention 1998-2003 (P1), early intervention 2004-2005 (P2), late intervention 2006-2009 (P3).
Results: A total of 342 CLABSI secondary to Staphylococcal species were identified over the 12 years of surveillance. Rates of infection per 1,000 catheter days were as follows:
Pre-intervention (P1)
Early Intervention (P2)
Late Intervention (P3)
% change (P1 vs P3; P2 vs P3 for MRSA)
Coagulase negative staph.
All S. aureus
Data incomplete
Conclusions: Following multiple interventions, CLABSI due to coagulase negative staphylococci were nearly eliminated and those due to S. aureus were reduced by over three-quarters. These findings highlight the utility of interventions that target skin flora (such as a hand hygiene campaign and adoption of the central line insertion bundle) against CLABSI secondary to Staphylococcal species.