Skip to main content
SpringerLink
Log in
Book cover

Annual Update in Intensive Care and Emergency Medicine 2015 pp 15–24Cite as

Central Line-associated Bloodstream Infections: A Critical Look at the Role and Research of Quality Improvement Interventions and Strategies

  • Chapter

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2015 ((AUICEM,volume 2015))

Abstract

Central venous catheters (CVC) are ubiquitous in the intensive care unit (ICU). Central lines are necessary for infusion, withdrawal of blood, or hemodynamic monitoring. Unfortunately, use of these devices predisposes to the development of central line-associated bloodstream infections (CLABSI). Approximately half of the patients admitted to the ICU require a CVC [1], and these catheters account for the majority of CLABSIs [2]. In the USA, up to 5 million CVCs are inserted each year and approximately 200,000 patients reportedly develop a CLABSI; the number of deaths attributable to these infections has been estimated at 25,000 (12.5%), equating to 0.5% of CVC insertions [3]. The 2009 Extended Prevalence of Infection in Intensive Care (EPIC II) study reported that, of 13,796 adult patients, 7,087 (51%) were classified as infected on the day of the study; BSIs accounted for 15% of these infections, however, this percentage includes BSIs of unknown origin (not related to an infection at another site, including intravascular-access devices) and secondary BSIs (related to an infection with the same organism at another site). CLABSIs were responsible for 4.7% of all ICU infections [4]. A 2011 systematic review calculated that CLABSIs were associated with the highest number of preventable deaths and associated costs compared to other healthcare-associated infections [5].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Mermel LA (2000) Prevention of intravascular catheter-related infections. Ann Intern Med 132:391–402

    Article  CAS  PubMed  Google Scholar 

  2. O’Grady NP, Alexander M, Burns LA et al (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52(162):193

    Google Scholar 

  3. Hockenhull JC, Dwan K, Boland A et al (2008) The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation. Health Technol Assess 12:iii–iv (xi–xii, 1–154)

    Article  CAS  PubMed  Google Scholar 

  4. Vincent JL, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302:2323–2329

    Article  CAS  PubMed  Google Scholar 

  5. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ (2011) Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 32:101–114

    Article  PubMed  Google Scholar 

  6. Blot SI, Depuydt P, Annemans L et al (2005) Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 41:1591–1598

    Article  PubMed  Google Scholar 

  7. Saint S, Veenstra DL, Lipsky BA (2000) The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful? Infect Control Hosp Epidemiol 21:375–380

    Article  CAS  PubMed  Google Scholar 

  8. Scott RD II (2009) The direct medical costs of healthcare-associated infections in u.s. hospitals and the benefits of prevention. http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf

    Google Scholar 

  9. Berenholtz SM, Lipsett PA, Pronovost PJ et al (2004) Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 32:2014–2020

    Article  PubMed  Google Scholar 

  10. Ranji SR, Shetty K, Posley KA et al (2007) Vol 6: Prevention of Healthcare–Associated Infections) Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  11. Eggimann P, Sax H, Pittet D (2004) Catheter-related infections. Microb Infect 6:1033–1042

    Article  Google Scholar 

  12. Timsit JF, Laupland KB (2012) Update on bloodstream infections in ICUs. Curr Opin Crit Care 18:479–486

    Article  PubMed  Google Scholar 

  13. Venkatram S, Rachmale S, Kanna B (2010) Study of device use adjusted rates in health care-associated infections after implementation of ‘bundles’ in a closed-model medical intensive care unit. J Crit Care 25:174 e11–174 e18

    Article  Google Scholar 

  14. Richardson J, Tjoelker R (2012) Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes. Clin Nurse Spec 26:205–211

    Article  PubMed  Google Scholar 

  15. Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D (2014) Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis 59:96–105

    Article  PubMed  Google Scholar 

  16. Safdar NAC (2008) Educational interventions for prevention of healthcare-associated infection: A systematic review. Crit Care Med 36:933–940

    Article  PubMed  Google Scholar 

  17. Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S (2013) Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database Syst Rev 3:CD006559

    PubMed  Google Scholar 

  18. Eccles M, Grimshaw J, Campbell M, Ramsay C (2003) Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 12:47–52

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Prior M, Guerin M, Grimmer-Somers K (2008) The effectiveness of clinical guideline implementation strategies – a synthesis of systematic review findings. J Eval Clin Pract 14:888–897

    Article  PubMed  Google Scholar 

  20. Longmate AG, Ellis KS, Boyle L et al (2011) Elimination of central-venous-catheter-related bloodstream infections from the intensive care unit. BMJ Qual Saf 20:174–180

    Article  PubMed  Google Scholar 

  21. Palomar M, Álvarez-Lerma F, Riera A et al (2013) Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med 41:2364–2372

    Article  PubMed  Google Scholar 

  22. Shannon RP, Frndak D, Grunden N et al (2006) Using real-time problem solving to eliminate central line infections. Jt Comm J Qual Patient Saf 32:479–487

    PubMed  Google Scholar 

  23. Koll BS, Straub TA, Jalon MS et al (2008) The CLABs collaborative: a regionwide effort to improve the quality of care in hospitals. Jt Comm J Qual Patient Saf 34:713–723

    PubMed  Google Scholar 

  24. Frankel HL, Crede WB, Topal JE et al (2005) Use of corporate Six Sigma performance-improvement strategies to reduce incidence of catheter-related bloodstream infections in a surgical ICU. J Am Coll Surg 201:349–358

    Article  PubMed  Google Scholar 

  25. Pronovost P, Weast B, Rosenstein B et al (2005) Implementing and validating a comprehensive unit-based safety program. J Patient Saf 1:33–40

    Article  Google Scholar 

  26. Pronovost P, Needham D, Berenholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732

    Article  CAS  PubMed  Google Scholar 

  27. DePalo VA, McNicoll L, Cornell M et al (2010) The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide. Qual Saf Health Care 19:555–561

    PubMed  Google Scholar 

  28. Watson SR, George C, Martin M et al (2009) Preventing central line-associated bloodstream infections and improving safety culture: a statewide experience. Jt Comm J Qual Patient Saf 35:593–597

    PubMed  Google Scholar 

  29. Bonello RS, Fletcher CE, Becker WK et al (2008) An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates. Jt Comm J Qual Patient Saf 34:639–645

    PubMed  Google Scholar 

  30. Render ML, Hasselbeck R, Freyberg RW et al (2011) Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf 20:725–732

    Article  PubMed  Google Scholar 

  31. Tang HJ, Lin HL, Lin YH, Leung PO, Chuang YC, Lai CC (2014) The impact of central line insertion bundle on central line-associated bloodstream infection. BMC Infect Dis 14:356

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    K. Blot, D. Vogelaers & S. Blot

Authors
  1. K. Blot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Vogelaers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Blot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Blot .

Editor information

Editors and Affiliations

  1. Université libre de Bruxelles, Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent Prof.

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Blot, K., Vogelaers, D., Blot, S. (2015). Central Line-associated Bloodstream Infections: A Critical Look at the Role and Research of Quality Improvement Interventions and Strategies. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13761-2_2

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13760-5

  • Online ISBN: 978-3-319-13761-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation