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237 From Insertion to Infection: Review of a medical center experience with catheter related infections

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Odaliz Abreu Lanfranco, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Kayoko Hayakawa, MD, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
George Alangaden, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Elaine Flanagan, MSA , Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI

Background:

Central line associated infections (CLABSIs) increase length of stay, mortality, and hospital costs. The Institute for Healthcare Improvement's (IHI) central line bundle is geared towards preventing infection and has been widely implemented by hospitals.  The IHI bundle focuses on catheter insertion rather than maintenance or line care and on infections in intensive care units (ICUs) as opposed to non-icu floors.

Objective:

To review the epidemiology and time from catheter insertion to infection for CLABSIs in our institution.  This analysis was used to assess whether infections occurred "early" (implicating inappropriate technique at the time of insertion) as opposed to "late" (implicating catheter care and maintenance issues).

Methods:

A retrospective review of CLABSIs was conducted from January 2009 to October 2010 from 5 hospitals (including 17 ICUs and all acute care floors) within the Detroit Medical Center. The infection control record, patient chart, and microbiology data was reviewed.

Results:  

A total of 114 CLABSIs were included, 76 (71%) in ICU and 38 (29%) in non-ICU floors. Pathogens in the ICU included: Gram-positive cocci (GPC) 43 (60%), gram negative bacilli (GNB) 26 (37%), polymicrobial 19 (26.7%) and candida 11 (15%). In non ICU floors pathogens included GPC 19 (52.7% ), candida 12 (33.3%), GNB 9  (25%), and polymicrobial 7 (19.4% ).

The most common types of catheters infected in the ICU were triple lumen catheters (TLCs) 32 (42%), while in the non ICU group, peripherally inserted central catheter (PICC) lines were the most common type of catheter infected 16 (42%).   In the ICU, 42 infections (59%) occurred in the first 5 days following insertion; and outside the ICU, 24 infections (66.7%) occurred greater than 10 days after insertion (graph 1).

Conclusions:

The epidemiology of CLABSI is notably different in ICU and non-ICU settings.  In the ICU, most infections involve TLCs and occur shortly after insertion, while in non-icu floors, PICC was the most common type of catheter infected and infections occurred several days following insertion. In order to optimally implement interventions geared towards CLABSI prevention, it is critical to understand the epidemiology of CLABSI in both ICU and non-ICU settings.