Use of an Antimicrobial Luer Activated Device on Peripherally Inserted Central Venous Catheters (PICCs) to Reduce Central Line Associated Bloodstream Infection Rates

Background: Each year up to 80,000 central line-associated bloodstream infections (CLABSIs) occur in patients cared for in Intensive Care Units (ICUs) in the United States. These infections are associated with increased morbidity and mortality rates in adult ICU patients, thus hospitals are implementing interventions to reduce these preventable complications.   In its 2002 Guidelines for the Prevention of Intravascular Catheter Related Infections, the Centers for Disease Control and Prevention recommends the use of an antimicrobial or antiseptic-impregnated central venous catheter if, after implementing a comprehensive strategy to reduce the rate of CLABSI, the CLABSI rate remains above the institution’s goal. Over a three year period, a 377 bed county regional medical center implemented specific strategies to reduce its CLABSI rate, including the addition of a dedicated PICC Team, the Institute for Hospital Improvement (IHI) central line bundle, a chlorhexidine impregnated protective disc and a clear, positive displacement, swabable connector.   These interventions are associated with decreasing the Adult ICU PICC CLABSI rate from 15.0% to 0.29%.

Objective: To further decrease CLABSI rates, an antimicrobial version of the clear, positive displacement, swabable connector was trialed.

Methods: In this prospective surveillance, CLABSI rates from April through July 2009 averaged 0.29% and analysis indicated these CLABSIs were attributed to catheter maintenance practices.  In August, 2009 the facility initiated a trial of an antimicrobial version of the clear, positive displacement connector as an intervention to further reduce the CLABSI rate.   Improper connector disinfection may lead to intraluminal microbial contamination of the connector.   In laboratory testing, the antimicrobial connector exhibits a 4 to 5-log reduction of several pathogens known to cause bloodstream infections. Reducing microbial contamination of the connector may decrease the risk of bloodstream infection.   No other interventions were implemented.   Prospective BSI surveillance and case finding were the responsibility of the PICC and the infection control teams. Infection rates were tracked monthly using the National Healthcare Safety Network definitions. Pre-intervention data was collected from April to July 2009 and post-intervention data from August to October, 2009.

Results: The pre-intervention period CLABSI rate was 0.29% in the Adult ICUs.  During the intervention period, CLABSI rate decreased to an average of .003%.

Conclusions: Reduction in CLABSI rates can be achieved through implementation of interventions such as the IHI central line bundle, a PICC Team, as well as additional practices and devices.   In this surveillance, an antimicrobial, positive displacement, clear swabable connector was associated with lowering Adult ICU CLABSI rates.