title: Central line-associated blood stream infection in the critically ill trauma patient.
abstract: Blood stream infections in the critically ill are a common cause of morbidity. Strict adherence to sterile technique can reduce central line-associated blood stream infections (CLBSIs) and has become a quality improvement measure. We did a retrospective review of 6,014 trauma admissions  representing 10,370 catheter days. CLBSI was defined as a positive blood culture with central venous access without evidence of other infectious sources. Thirty-five CLBSIs were identified in the study period (3.26/1,000 line days). The average Injury Severity Score was 32, the average intensive  care unit stay was 24 days, and the average overall length of stay was 34 days, which is higher than that of nonCLBSI patients. In 25/35 cases, there was a break in sterile technique during central venous catheter placement (71%). Of the 25 cases, 16 of them were performed in the intensive  care unit (64%), five in the operating room (20%), and four in the emergency department (16%). Twenty of the 35 patients with CLBSI (57%) had a total of 24 infections, a 2-fold increase in infectious complications for a given Injury Severity Score. Seventeen (17) of the 25 "dirty"  central lines (68%) were changed within 24 hours in an effort to reduce the risk of CLBSI without success. A large percentage of CLBSI can be traced to the initial placement of a central venous line under less than ideal sterile technique. Changing a line within 24 hours may not be sufficient  to reduce the risk of CLBSI. Every effort should be made to adhere to proper sterile technique while placing central venous catheter.
authors.affiliation: University of Louisville, Louisville, Kentucky, USA. j0smit19@louisville.edu
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Egger
authors.forename: Glen
authors.initials: G
authors.lastname: Franklin
authors.forename: Brian
authors.initials: B
authors.lastname: Harbrecht
authors.forename: J David
authors.initials: JD
authors.lastname: Richardson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology*; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*