Central Line-Associated Bloodstream Infection: Reducing Risks through Access Management

Highlights

The authors of this retrospective cohort study sought to evaluate the association between central line-associated bloodstream infections (CLABSI) and central line access in pediatric patients.
The number of daily central line accesses was significantly and independently associated with the risk of a CLABSI within the next 3 days. A large percentage of medications administered through the central line were also compatible with peripheral intravenous administration.
These results highlight the important risk of central line access in the development of CLABSI and also suggest that it is feasible to decrease the number of accesses which may significantly reduce the risk of hospital-acquired infections.

Goals

Identification of modifiable risk factors associated with central line-associated bloodstream infections (CLABSI) may lead to modifications in central line (CL) management . We hypothesize that the number of CL accesses per day is associated with an increased risk of CLABSI and that a significant fraction of CL access can be substituted with non-CL routes.

Design

We conducted a retrospective cohort study of patients with at least one day of CL device from January 1, 2015 to December 31, 2019. A mixed-effects multivariate logistic regression model was used to estimate the association between the number of CL accesses on a given CL Device Day and CLABSI prevalence within the next 3 days.

Setting

A 395-bed pediatric academic medical center.

Patients

Patients with at least one CL device from January 1, 2015 to December 31, 2019.

Interventions: none

Main outcome measures

There were 138,411 eligible central line (CL) device days in 6543 patients, with 639 device days within 3 days of central line-associated bloodstream infections (CLABSIs) (a total of 217 CLABSIs).

The number of CL accesses per day was independently associated with the risk of CLABSI in the next 3 days (adjusted odds ratio, 1.007; 95% CI, 1.003-1.012; P = 0.002).

Of medications administered via CL, 88% were candidates for delivery via a peripheral line. On average, these accesses contributed a 6.3% increase in daily risk for CLABSI.

Conclusions

The number of daily CL accesses is independently associated with the risk of central line-associated bloodstream infections (CLABSI) in the next 3 days.
In the pediatric population examined, most medications administered via CL could be safely administered peripherally.
Efforts to reduce access to CL may be an important strategy to include in contemporary CLABSI prevention packages.

Central Line-Associated Bloodstream Infection: Reducing Risks through Access Management

Strategies to minimize central line accesses hold promise for significantly reducing the risk of central line-associated bloodstream infections, enhancing patient safety in healthcare settings.