Risk factors for central line-associated bloodstream infections in the era of best practice.
BACKGROUND
Best clinical practice aims to eliminate central line-associated blood stream infections (CLABSIs). However, CLABSIs still occur. This study's aim was to identify risk factors for CLABSI in the era of best practice.


METHODS
Critically ill surgical patients admitted over 2 years to the intensive care unit (ICU) for ≥ 4 days were studied. Patients with CLABSI as cause for ICU admission were excluded. Patients who developed CLABSI (National Healthcare Safety Network definition) were compared with those who did not. Hand hygiene, maximal sterile barriers, chlorhexidine scrub, avoidance of femoral vein, and proper maintenance were emphasized. Variables collected included demographics, diagnosis, and severity of illness using the Acute Physiology and Chronic Health Evaluation (APACHE) IV database and the hospital central data repository.


RESULTS
Of 961 patients studied, 51 patients (5.2%) developed 59 CLABSIs. Mean time from ICU admission to CLABSI was 26 days ± 26 days. The CLABSI group was more likely to be male (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.02-3.68), more critically ill on ICU admission (APACHE IV score 85.2 ± 21.9 vs. 65.6 ± 23.2, p < 0.01), more likely admitted to the emergency surgery service (OR 1.92, 95% CI 1.02-3.61), and had an association with reopening of recent laparotomy (OR 2.08, 95% CI 1.10-3.94).


CONCLUSIONS
In the era of best practice, patients who develop CLABSI are clinically distinct from those who do not develop CLABSI. These CLABSIs may be due to deficiencies of the CLABSI definition or represent patient populations requiring enhanced prevention techniques.


METHODS
III, prognostic study.
Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Mlissauer@umm.edu
Matthew E
ME
Lissauer
Surbhi
S
Leekha
Michael Anne
MA
Preas
Kerri A
KA
Thom
Steven B
SB
Johnson
D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology