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Risk factors for central line-associated bloodstream infections in the era of best practice

Lissauer, Matthew E. MD; Leekha, Surbhi MBBS; Preas, Michael Anne RN; Thom, Kerri A. MD, MS; Johnson, Steven B. MD

The Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1174–1180
doi: 10.1097/TA.0b013e31824d1085
AAST 2011 Plenary Papers

BACKGROUND: Best clinical practice aims to eliminate central line-associated blood stream infections (CLABSIs). However, CLABSIs still occur. This study's aim was to identify risk factors for CLABSI in the era of best practice.

METHODS: Critically ill surgical patients admitted over 2 years to the intensive care unit (ICU) for ≥4 days were studied. Patients with CLABSI as cause for ICU admission were excluded. Patients who developed CLABSI (National Healthcare Safety Network definition) were compared with those who did not. Hand hygiene, maximal sterile barriers, chlorhexidine scrub, avoidance of femoral vein, and proper maintenance were emphasized. Variables collected included demographics, diagnosis, and severity of illness using the Acute Physiology and Chronic Health Evaluation (APACHE) IV database and the hospital central data repository.

RESULTS: Of 961 patients studied, 51 patients (5.2%) developed 59 CLABSIs. Mean time from ICU admission to CLABSI was 26 days ± 26 days. The CLABSI group was more likely to be male (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.02–3.68), more critically ill on ICU admission (APACHE IV score 85.2 ± 21.9 vs. 65.6 ± 23.2, p < 0.01), more likely admitted to the emergency surgery service (OR 1.92, 95% CI 1.02–3.61), and had an association with reopening of recent laparotomy (OR 2.08, 95% CI 1.10–3.94).

CONCLUSION: In the era of best practice, patients who develop CLABSI are clinically distinct from those who do not develop CLABSI. These CLABSIs may be due to deficiencies of the CLABSI definition or represent patient populations requiring enhanced prevention techniques.

LEVEL OF EVIDENCE: III, prognostic study.

Baltimore, Maryland

From the Program in Trauma (M.E.L., S.B.J.), Department of Epidemiology and Public Health (S.L., K.A.T.), Infection Prevention and Control (M.A.P.), University of Maryland School of Medicine, Baltimore, Maryland.

Submitted: September 7, 2011, Revised: January 16, 2012, Accepted: January 19, 2012.

Presented at the 70th Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 14–17, 2011, Chicago, Illinois.

Address for reprints: Matthew Lissauer, MD, 22 South Greene Street, Room S4D07, Baltimore, MD 21201; email:

© 2012 Lippincott Williams & Wilkins, Inc.