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Background: Most of the attention on central line related blood stream infections (CLABSI) has focused incidence and prevention efforts in the ICU setting. Many patients with central lines are hospitalized outside the ICU, but the burden of CLABSI is less well defined on general medical hospital units.
Objective: We performed a multi-hospital surveillance for CLABSI in units outside ICU and compared the incidence of infections reported from the ICUs.
Methods: Six hospitals in the Rochester area enrolled 37 non-ICU adult patient care units in this collaborative study. Active surveillance was performed for 18 months using NHSN definitions. For units outside the ICU, an estimate of the line-days (l-d) using the device use ratio (DUR) was used to calculate the CLABSI rate on each unit. The estimate of line-days has been validated locally and is recommended as an option in settings with a limited workforce.
Results: The rates of CLABSI on select floors outside the ICU for the 18 months are shown in the table. Special care units, primarily oncology and transplant, saw higher rates of infection. The higher rates of infection seen with tunneled CVC (TCVC) probably reflect the use of these catheters on special care units. Overall, 4.4 % of line days included more than one central line.
In 2008, these 6 hospitals reported 75 infections in 27 600 line days in the ICU, for a rate of 2.7 per 1000 l-d. This is similar to the rate of 2.5 seen outside the ICU. Adjusted for the different time intervals, there were 2.2 times as many infections (164 / 75) and 3.5 times as many line days on selected floors outside the ICU (64 900 / 27 600).
Conclusions: The majority of line-days and CLABSI occur outside the ICU. As rates in the ICU fall, attention to this significant patient risk should shift to improved patient care for patients outside the ICU, where strategies need to adjust for different line types and longer catheter retention times.