Central Line-Associated Bloodstream Infections - Surveillance and Investigation

Overview

Central line-associated bloodstream infections (CLABSIs) occur when germs enter the bloodstream through a central line. A central line is a tube that is placed in a large vein to give fluids, blood, or medications, or to do certain medical tests quickly.

Some patients may be at higher risk for developing a CLABSI due to length of hospitalization before catheterization, duration of catheterization, prematurity, underlying medical conditions, location of catheter placement, or other factors. (citation) It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.

Estimated burden of CLABSIs in healthcare facilities in the United States:

Morbidity
- Bloodstream infections represent 10% of all HAIs, comprising an estimated 71,900 infections in U.S. hospitals annually. (citation)
  - More than three-quarters (84%) of bloodstream infections in acute care hospital settings are estimated to be associated with a central line.
  - An estimated 15,600 central line-associated bloodstream infections occur in non-neonatal intensive care units annually.
- According to the latest CDC National and State HAI Progress Report, in 2014, acute care hospitals experienced a 50% reduction in hospital-onset central line-associated bloodstream infections compared to 2008.
  - Virginia hospitals experienced a 50% reduction in hospital-onset central line-associated bloodstream infections between 2008 and 2013.
- 2011 CDC Vital Signs Report (citation)
  - Approximately 41,000 CLABSIs in acute care hospitals each year.
    - In 2009, about 18,000 CLABSIs occurred in patients in intensive care units
    - About 23,000 more occurred in patients who got treatment in other areas of the hospital
  - In 2008, about 37,000 CLABSIs occurred in patients receiving outpatient hemodialysis treatment
- CLABSIs lead to longer length of hospital stay.
Mortality
- Of patients who get a CLABSI, up to 1 in 4 die. (citation)
Costs (citation)
- Estimated cost per infection ranges from $6,000 – $29,000
- Estimated total cost in the United States ranges from $0.6 billion – $2.7 billion annually

In July 2008, Virginia hospitals with one or more adult intensive care units began reporting their CLABSI data to the Virginia Department of Health (VDH) through the National Healthcare Safety Network (NHSN).

In January 2011, the Centers for Medicare and Medicaid Services (CMS) began requiring acute care hospitals participating in their Hospital Inpatient Quality Reporting Program (IQR) to report CLABSIs in adult, pediatric, and neonatal intensive care units. In January 2015, CMS began requiring acute care hospitals to report CLABSIs in adult and pediatric medical, surgical, and medical/surgical inpatient wards. Critical care data are currently available and inpatient ward data will soon be available to the public on Hospital Compare.

In September 2015, the VDH reporting regulations were updated to align state reporting requirements with the CMS Hospital Inpatient Quality Reporting Program. Under the new regulations, hospitals are reporting CLABSI data to VDH through NHSN for adult, pediatric, and neonatal critical care units and adult and pediatric medical, surgical, and medical/surgical inpatient wards. For more information on these data and the state regulations mandating their reporting, please see Public Reporting page

Other CMS quality reporting programs require CLABSI reporting from long-term acute care hospitals (adult and pediatric critical care units and ward locations – October 2012 to present).

VDH HAI Program activities to address this issue:

CLABSI data audit (October 2010 – February 2011): Reviewed positive blood culture results from 37 hospitals to assess the validity of reported CLABSI data. Interviewed infection prevention staff to identify educational gaps with data collection and surveillance definitions.
- CLABSI webinar to share lessons learned from audit (May 2011)
- CLABSI data audit final report

Prevention Strategies for Healthcare Providers

To prevent CLABSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

Follow recommended central line insertion practices to prevent infection when the central line is placed, including:
- Perform hand hygiene
- Apply appropriate skin antiseptic
- Ensure that the skin prep agent has completely dried before inserting the central line
- Use all five maximal sterile barrier precautions:
  - Sterile gloves
  - Sterile gown
  - Cap
  - Mask
  - Large sterile drape
Once the central line is in place:
- Follow recommended central line maintenance practices
- Wash hands with soap and water or an alcohol-based handrub before and after touching the line
Remove a central line as soon as it is no longer needed. The sooner a catheter is removed, the less likely the chance of infection.

2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections

SHEA/IDSA Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals – CLABSI

CDC CLABSI toolkit for non-intensive care unit (ICU) settings – contains background on epidemiology of CLABSIs as well as core and supplemental prevention strategies

Tools and Resources

AHA/HRET Hospital Engagement Network 2.0 – change package, improvement strategies, checklist, and other resources

APIC Guide to the Elimination of Catheter-Related Bloodstream Infections, 2009

CDC National Healthcare Safety Network (NHSN) Validation Guidance and Toolkit for 2012: Validation for Central Line-Associated Bloodstream Infection (CLABSI) in Intensive Care Units – resource to assist with internal or external validation of CLABSI data from ICUs. Includes recommended approaches to investigate and enhance the accuracy and completeness of 2012 CLABSI data in NHSN.

CDC Vital Signs Report: Making Health Care Safer – Reducing Bloodstream Infections (March 2011) – latest findings of progress on CLABSI prevention in different healthcare settings (hospitals and dialysis centers)

Morbidity and Mortality Weekly Report (MMWR) – March 4, 2011 – more detailed information on methodology of Vital Signs report

Comprehensive Unit-Based Safety Program (CUSP) – safety project designed to improve safety culture and reduce CLABSI infections in participating hospitals. In Virginia, this project is led by the state hospital association, Virginia Hospital & Health Association (VHHA).

NHSN CLABSI protocol, training, forms, analysis resources, and support materials – click on the appropriate healthcare setting and select the CLABSI link to access the materials

SHEA Patient Education Guide (BSI) – fact sheet that educates patients and their families about 7 types of HAIs (including CLABSIs) and how to work with healthcare professionals to prevent them.

For more patient resources, please see the Consumer and Public Information page or go to the CDC CLABSI website.