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• W2016049857 abstract "Central line-associated bloodstream infection (CLABSI) is a major health care burden in the intensive care unit (ICU) setting.1Soufir L. Timsit J.F. Mahe C. Carlet J. Regnier B. Chevret S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study.Infect Control Hosp Epidemiol. 1999; 20: 396Crossref PubMed Scopus (268) Google Scholar, 2Warren D.K. Quadir W.W. Hollenbeak C.S. Elward A.M. Cox M.J. Fraser V.J. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital.Crit Care Med. 2006; 34: 2084Crossref PubMed Scopus (256) Google Scholar Many risk factors associated with central lines have been studied with mixed results.3McGee D.C. Gould M.K. Preventing complications of central venous catheterization.N Engl J Med. 2003; 348: 1123-1133Crossref PubMed Scopus (1657) Google Scholar, 4Lorente L. Henry C. Martin M.M. Jimenez A. Mora M.L. Central venous catheter-related infection in a prospective and observational study of 2595 catheters.Crit Care. 2005; 9: R6315Google Scholar, 5Maki D.G. Kluger D.M. Crnich C.J. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.Mayo Clin Proc. 2006; 81: 1159-1171Abstract Full Text Full Text PDF PubMed Scopus (1061) Google Scholar, 6McConnell S.A. Gubbins P.O. Anaissie E.J. Do antimicrobial-impregnated central venous catheters prevent catheter-related bloodstream infection?.Clin Infect Dis. 2003; 37: 65-72Crossref PubMed Scopus (86) Google Scholar, 7Fraenkel D. Rickard C. Thomas P. Faoagali J. George N. Ware R. A prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters.Crit Care Med. 2006; 34: 668-675Crossref PubMed Scopus (86) Google Scholar Although it has long been accepted that increased duration of a central line leads to higher infection rates,8Gil R.T. Kruse J.A. Thill-Baharozian M.C. Carlson R.W. Triple- vs single-lumen central venous catheters: a prospective study in a critically ill population.Arch Intern Med. 1989; 149: 1139-1143Crossref PubMed Google Scholar little attention beyond central line bundle is paid to the factors contributing to CLABSI development. Recently, more attention has focused on reminding staff to remove lines that are not medically necessary using a daily goals checklist.9Pronovost P. Needham D. Berenholtz S. Sinopoli D. Chu H. Cosgrove S. et al.An intervention to decrease catheter-related bloodstream infections in the ICU.N Engl J Med. 2006; 355: 2725-2732Crossref PubMed Scopus (3243) Google Scholar Audits of line necessity with feedback to staff may have a desirable impact on staff behavior but are not routinely performed. We performed a retrospective audit of patients with CLABSI in a surgical ICU at a large academic teaching center to assess the burden of infected lines that were left in longer than medically necessary. To determine medical necessity, we established criteria for conditions requiring a central line as follows: irritant and vesicant medication use, total parenteral nutrition administration, dialysis, and hemodynamic instability (defined as use of a vasopressor or inotrope, mean arterial pressure < 60 or heart rate > 100). If no documented indication could be found in the paper or electronic medical record for greater than 48 hours, it was assumed that the line was unnecessary (see Fig 1). In our cohort of patients from January 1, 2009, through December 31, 2009, there was a total of 33 CLABSI in 30 patients whom we audited for several variables that may have contributed to infection. Of these, 27 of 33 lines were temporary central venous catheters. Using our criteria, 6 of 27 (22%) culture-positive lines were in place longer than medically necessary. These data support the premise that unnecessary lines contribute significantly to the total burden of CLABSI. After this study, our institution has begun collecting data within 1 week of confirmed CLABSI in all ICUs to determine the factors, other than bundle compliance, that could have been modified to prevent infection. We started investigating line necessity on each CLABSI and are providing feedback to the ICU staff. The number of infected lines that were left in longer than medically necessary was zero in our study ICU from June through December 2010. Our findings resonate with the well-known concerns that surround the subject of CLABSI reduction measures. The methods we used to determine central line necessity are easily reproducible and appear to be helpful to provide feedback to health care workers and ultimately reduce infections. The authors thank Julie E. Mangino, MD, for editorial review of this manuscript." @default.
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• W2016049857 date "2012-02-01" @default.
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• W2016049857 title "Assessment beyond central line bundle: Audits for line necessity in infected central lines in a surgical intensive care unit" @default.
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• W2016049857 doi "https://doi.org/10.1016/j.ajic.2011.06.004" @default.
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