Risk Factors for Central Line–Associated Bloodstream Infections in the Era of Prevention Bundles

Abstract

Little is known about central line-associated bloodstream infection risk factors in the bundle era. In our case-control investigation, we found that independent risk factors for central line-associated bloodstream infection at our center included the number of recent lab tests, catheter duration, and lack of hemodynamic monitoring as the insertion indication. Infect Control Hosp Epidemiol 2014;00(0): 1-3.

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients

“…Another factor that may have influenced the reduction of CRBSI is the inclusion of daily bathing with 2% chlorhexidine gluconate, which is normally not included in the bundle measures 6 , 10 . The use of chlorhexidine instead of normal soap is based on reducing the bacterial colonization on the patient’s skin, which can enter the bloodstream via the extraluminal CVC route 21 .…”

“…There are several risk factors associated with CRBSI, such as: duration of catheterization, number of lumens, femoral access site, excessive manipulation of the CVC, total parenteral nutrition, bacterial colonization at the insertion site, prolonged hospitalization, and others 10 - 12 . There are several strategies to prevent CRBSI, and bundles are recognized as one of the most used and most effective for the reduction of CRBSI 10 , 13 . Bundles can be defined as the systematic implementation of a set of evidence-based practices, usually three to five, that, when performed properly and collectively, can improve patient outcomes 13 .…”

Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital

“…MIPD can also handle TDM concentrations collected at any time during the treatment course, allowing for more flexibility in the timing of samples. This flexibility is valuable in neonates and young children by allowing TDM samples to be timed with other clinical laboratories, minimizing painful venipunctures (Shah and Ohlsson, 2011) or central line entries that are associated with infections (Callister et al, 2015). The flexibility in timing also allows use of TDM samples drawn at the "incorrect" time, and therefore, no information about the patient is lost.…”

A proposal for a comprehensive approach to infections across the surgical pathway

“…CRBSIs can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines, and appropriate site selection. Different measures have been implemented to reduce the risk for CRBSI, including the use of maximal barrier, precautions during catheter insertion, effective cutaneous anti-sepsis, and preventive strategies based on inhibiting microorganisms originating from the skin or catheter hub from adhering to the catheter [34]. The simultaneous application of multiple recommended best practices to manage CVCs has been associated with significant declines in the rates of CRBSI.…”

“…33 Department of Surgery, Marche Polytechnic University of Marche Region, Ancona, Italy. 34 Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. 35 Unit of Microbiology and Virology, San Filippo Neri Hospital, Rome, Italy.…”