Newark Beth Israel Medical Center, USA

Dartmouth Hitchcock Medical Center, USA

Florida Hospital Memorial Medical Center, Bert Fish Medical Center and Halifax Medical Center, USA

Hospital associated infections (HAIs) are defined by the CDC

as “infections that patients develop while they are receiving care in a health care setting for another condition with the estimated incidence of HAIs in the United States in 2012 being 4.5 per 100 patients” [1]. In 1950, the American Hospital. Association recommended that hospitals begin surveillance for HAIs due to a surge in infections caused by Staphylococcus aureus seen in postoperative patients. Today, bloodstream infections represent 14% [1] of all HAIs in the United States. Most of these bloodstream infections have been associated with central venous catheters (CVCs), which are defined by the National Healthcare Safety Network (NHSN) as “intravascular catheters that terminate at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring” [2]. In

the US alone, the associated cost attributed to HAIs in 2012 was approximately 28–33 billion dollars [3]. HAIs continue to be a significant source of morbidity and mortality in the US Healthcare system. Bloodstream infections are divided

into two categories: central line associated bloodstream infec- tions (CLABSIs) and catheter-related bloodstream infections

 (CRBIs). The term CLABSI refers primarily to bloodstream infections in a patient with a central line in place within the 48-hour period before onset of the bloodstream infection that is not related to infection at another site. CRBIs, on the other hand, are bloodstream infections that require specific

laboratory testing to identify the catheter as the origin of the

infection; this testing is not a part of the criteria for a CLABSI.

It is estimated that 41,000 CLABSIs occur in U.S. hospitals

annually with an associated cost of $16,550.47 per infection

and an increased length of stay [4]. These infections have

been associated with an estimated inpatient mortality rate of

Hindawi Publishing Corporation

Journal of Critical Care Medicine

Volume 2015, Article ID 635939, 8 pages

http://dx.doi.org/10.1155/2015/635939

2 Journal of Critical Care Medicine

12–25% [5]. For the purposes of surveillance, the definition

of a CLABSI is more practical, but it comes with its own

limitations. It has been noted by the Joint Commission that

this definition may overestimate the actual rate of infections

from central lines as opposed to another remote site.

In 2012, at Newark Beth Israel Medical Center (NBIMC),

a total number of 68 CLABSIs were recorded in the adult

population, and the resulting total represented a figure above

the national benchmark. This elevated number of infections

 

prompted the question, “what can we do as a teaching insti-

tution to reduce the rate of these bloodstream infections?” In

 

2011, in the Clinical Journal of Infectious Disease, Mermel

et al. made an important note that the pathogenesis of

catheter infections is a multifactorial process where both

intraluminal and extraluminal causes must be investigated

[6]. For this reason, we focused on multiple strategies targeted

at reduction. A multidisciplinary CLABSI prevention task

force was formed to examine our practices with regard to

central line insertion, maintenance, and removal, and to

implement a stringent policy that promoted tight adherence

to CDC practice bundle elements with a unified approach

that involved physicians and nurses actively monitoring each

hospital unit. The objective of this paper is to evaluate the

impact the implementation of a multidisciplinary task force

dedicated to appropriate central line insertion can have on

reducing rates of CLASBIs.