Central Line-Associated Bloodstream Infection (CLABSI) Surveillance Crosses the Red Line into the Operating Room (OR)

Background: CLABSI prevention bundles are standard practice in most inpatient settings now, but other areas of the hospital where central catheters are inserted or accessed, such as operating rooms, are often overlooked.  A retrospective review in our pediatric intensive care unit between January 2004 and December 2006, indicated that nearly half of the CLABSIs occurred in patients who had their central catheters inserted or accessed in the operating room within 7 days preceding infection.  This data suggested that there may be opportunities for improvement in adherence to central catheter insertion and maintenance bundles in the OR.

Objective: To evaluate the incidence of post-surgical CLABSI in patients who had central catheters inserted or accessed in our pediatric OR.

Methods: In our pediatric OR, the general surgery service and anesthesiology were the primary groups inserting central lines; anesthesiology was the major service accessing lines intraoperatively.  Between October 2008 and July 2009, all patients undergoing central catheter insertions by general surgery were included in the study.  From May 2009 through July 2009, reports of all patients having central catheters inserted and accessed by anesthesiology were obtained from anesthesiology procedure notes and intraoperative records.  An electronic medical record search engine was used to identify any positive microbiology cultures within 7 days of the central catheter insertion or anesthesiology access in the operating room.  NHSN definitions were used to confirm CLABSI in the 7 days following insertion or access in the OR.  Catheter days were calculated for tunneled catheters and ports for the 7 day post insertion observation period.

Results: From October 2008 through July 2009, general surgery placed 252 central catheters, with 1764 catheter days; 92% were tunneled catheters or ports.  In this cohort, 1 CLABSI was identified (0.4 CLABSI/100 catheters or 0.6 CLABSIs/1000 catheter days).  Between May 2009 and July 2009, 330 patients had central catheters inserted or accessed by anesthesiology.  Temporary central venous catheters comprised 85% of the catheters placed and accessed by anesthesiology.  In this cohort, 2 CLABSIs were identified, (0.6 CLABSIs/100 catheters inserted or accessed).

Conclusions: In our pediatric hospital, rates of CLABSI in central catheters inserted or accessed in the OR are low.  Despite the low rates in the surgical population, the ability to monitor post-surgical CLABSIs will be an important next step in reducing pediatric CLABSIs hospital-wide.