The number of such infections in intensive care units in the U.S. has fallen markedly because of improved central line insertion and maintenance techniques.

Central line–associated bloodstream infections (CLABSIs) are common and often fatal (mortality rate, 12%–25%). In 2002, the CDC issued guidelines for the prevention of such infections. Have these guidelines had the desired effect?

To answer this question, CDC researchers — using several national data sources — estimated the number of CLABSIs among patients aged 1 year in intensive care units (ICUs) in the U.S. before and after publication of the guidelines. For 2001, the number of CLABSIs (after adjustment to account for a change in CLABSI definition in 2008) was estimated to be 43,000. For 2009, the number was estimated to be 18,000 — a 58% reduction.

The researchers also estimated that 37,000 CLABSIs occurred in outpatient hemodialysis facilities in 2008, and that 23,000 occurred on non-ICU inpatient wards in 2009. These categories have no corresponding data for 2001 but provide benchmarks for future comparison.

Comment: Although the definition of CLABSI has changed over the years, and some infections may have gone undiagnosed because blood cultures were not performed, the number of CLABSIs in ICUs has dropped significantly. The use of meticulous placement and care techniques in this setting is no doubt responsible.

In non-ICU settings, where central lines are less frequently inserted, rate reductions may be harder to achieve. Additional preventive strategies (particularly measures designed to improve central line maintenance, to ensure prompt removal of unneeded lines, and to reduce central line use for hemodialysis) will be necessary in these venues to produce CLABSI decreases similar to those realized in ICUs.

— Stephen G. Baum, MD

Published in Journal Watch Infectious Diseases