Central line infections in ICUs fell 58% between 2001 and 2009

Central line-associated bloodstream infections (CLABSIs) in ICUs dropped 58% between 2001 and 2009, the Centers for Disease Control and Prevention reported last week.

CDC researchers multiplied central line utilization and CLABSI rates by estimates of the total number of patient-days in ICUs, inpatient wards and outpatient hemodialysis facilities. They used the Healthcare Cost and Utilization Project's National Inpatient Sample and the Hospital Cost Report Information System to identify total inpatient days; CLABSI and central line use rates came from the National Nosocomial Infections Surveillance Systems for 2001 estimates (ICUs only) and from the National Healthcare Safety Network (NHSN) for 2009 estimates (ICUs and inpatient wards). Total number of outpatient hemodialysis patient-days in 2008 came from the U.S. Renal Data System; outpatient hemodialysis central line utilization data came from the Fistula First Breakthrough Initiative; and hemodialysis CLABSI rates were estimated from the NHSN. Results were published online March 1 by the CDC's Morbidity and Mortality Weekly Report.

ICU CLABSIs fell to about 18,000 cases in 2009 from about 43,000 cases in 2001. Reductions in infections caused by Staphylococcus aureus were greatest (73% reduction; rate ratio [RR], 0.27; 95% CI, 0.238 to 0.294), followed by those caused by Enterococcus species (55% reduction; RR, 0.45; 95% CI, 0.408 to 0.491), Candida species (46% reduction; RR, 0.54; 95% CI, 0.487 to 0.606) and gram-negative pathogens (37% reduction; RR, 0.63; 95% CI, 0.568 to 0.692). Overall, the decline in infections saved up to 6,000 lives and $414 million in potential excess health care costs in 2009, and an estimated $1.8 billion in cumulative excess health care costs since 2001. Still, a substantial number of CLABSIs occurred in inpatient wards and outpatient hemodialysis centers. While data for 2001 weren't available, there were an estimated 23,000 CLABSIs in inpatient wards in 2009 and 37,000 in outpatient hemodialysis centers in 2008.

Collaboration among health care facilities, professional societies and state and federal agencies to implement proven best practices for central line insertion has likely helped reduce CLABSIs in ICUs, the report concluded. Such efforts may have limited impact outside the ICU, where central lines are less frequently inserted, so extra prevention strategies should be developed, it said. “Implementation of CDC recommendations to maintain central lines, remove them promptly when they are no longer needed, and interrupt transmission of resistant bacteria will reduce CLABSIs further,” the report said. Study limitations include that estimates were calculated rather than measured directly, and that differences between facilities reporting and not reporting data to CDC may have affected the accuracy of estimates.