Simultaneous placement of multiple central lines increases central line-associated bloodstream infection rates.
BACKGROUND
Surveillance for central line (CL)-associated bloodstream infections (CLABSIs) is generally advocated. However, the standard definition of this surveillance does not take into account the number of CLs in place and thus the possibility of increased infection risk with multiple CLs in place simultaneously. In this study, we tested the hypothesis that simultaneous placement of more than 1 CL is associated with an increased CLABSI rate.


METHODS
The number of CLs, CL-days, and CLABSIs and CLABSI rates with regard to the number of CLs in place simultaneously was documented in 2 intensive care units between 2001 and 2011. Standard CLABSI rates, as well as the rates for 1 CL and multiple CLs in place, were calculated.


RESULTS
The average CLABSI rate was significantly lower in patients with 1 CL in place compared with those with more than 1 CL in place (3.69 per 1,000 CL-days vs 13.09/1,000 CL-days; incidence rate ratio [IRR], 3.63; 95% confidence interval [CI], 2.61-5.05). Importantly, all differences from the standard rate (5.94/1,000 CL-days) were significant (1 CL vs standard: IRR, 0.61; 95% CI, 0.51-0.74; more than 1 CL vs standard: IRR, 2.23; 95% CI, 1.87-2.65; both P < .0001).


CONCLUSIONS
Our data show that the number of CLs in place had a strong influence on CLABSI rates. Thus, we advocate stratifying patients by the number of CLs in place to take this increased risk of infection into account during surveillance.
Departments of Infection Control and Infectious Diseases, University Hospital Aachen, RWTH Aachen, Aachen, Germany. sscheithauer@ukaachen.de
Simone
S
Scheithauer
Helga
H
Häfner
Jörg
J
Schröder
Alexander
A
Koch
Vedranka
V
Krizanovic
Katharina
K
Nowicki
Ralf-Dieter
RD
Hilgers
Sebastian W
SW
Lemmen
D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D018805:Sepsis / Q000453:epidemiology*