Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

Couk, Jesse; Tejedor, Sheri Chernetsky; Steinberg, James P.; Robichaux, Chad; Jacob, Jesse T

doi:10.1017/ice.2019.180

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…Regarding COVID-19 specifically, international studies suggest that the choice of puncture site should be in the infraclavicular region to reduce exposure to oral and tracheal fluids, avoiding catheter-related infections; however, these sites increase the risk of pulmonary complications of mechanical ventilation ( 7 - 8 ) . An US cohort study observed that the risk of CLABSI increases proportionally to the number of lumens in the device ( 17 ) . Our study found that the majority of catheters were double lumen (96.4%) inserted into the jugular (80%).…”

Section: Discussionmentioning

confidence: 99%

Central line-associated bloodstream infections in patients with COVID-19

Acosta,

Ceratti,

Santos

et al. 2024

Rev. Latino-Am. Enfermagem

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Objective: to investigate the association between central line-associated bloodstream infections and clinical and care variables of intensive care unit patients with COVID-19 hospitalized at a reference public health institution. Method: a case-control study. Results: the study sample consisted of 70 patients diagnosed with central line-associated bloodstream infections (case group) and 70 non-infected patients (control group). Most patients were male, with mean age of 57.93±13.93 years old and provided with a double lumen catheter. Median time of central line-associated bloodstream infections onset was 11 (8-18) days. Longer time on mechanical ventilation ( P =0.014; OR: 1.79; 95% CI: 0.91-3.51) and prone position ( P =0.017; OR: 2.41; 95% CI: 1.22-4.81) were associated with central line-associated bloodstream infections onset. Conclusion: longer time on invasive mechanical ventilation and prone position contributed to central line-associated bloodstream infections onset in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Central line-associated bloodstream infections in patients with COVID-19

Acosta,

Ceratti,

Santos

et al. 2024

Rev. Latino-Am. Enfermagem

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“…Attempts at estimating the increase in CLABSI risk due to CVC concurrence have been made by others. 15,[31][32][33][34] Our estimates are lower than those observed in single medical center study from 2014 by Concannon et al 33 that quantified the attributable risk; however, the size of the study was smaller, and more importantly, it approached risk adjustment differently. Concannon et al 33 used more traditional logistic regression adjusting for markers associated with disease severity.…”

Section: Figure Time Tomentioning

confidence: 99%

“…Other investigators have demonstrated the varied effects of counting total CLD would have on CLABSI rates. 15,34,35 Based on these studies, the effect of comparing CLABSI rates using NHSN CLDs vs total CLDs appears to depend on the frequency of concurrent CVC use in the study population and the definition of concurrence (eg, any overlap at single time of day, at least several hours of overlap, entire days of overlap). Although simply counting all CLDs may be a simple approach to improving risk adjustment, it may not be the best approach.…”

Section: Figure Time Tomentioning

confidence: 99%

Comparison of Rates of Central Line–Associated Bloodstream Infections in Patients With 1 vs 2 Central Venous Catheters

et al. 2020

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IMPORTANCE National Healthcare Safety Network methods for central line-associated bloodstream infection (CLABSI) surveillance do not account for potential additive risk for CLABSI associated with use of 2 central venous catheters (CVCs) at the same time (concurrent CVCs); facilities that serve patients requiring high acuity care with medically indicated concurrent CVC use likely disproportionally incur Centers for Medicare & Medicaid Services payment penalties for higher CLABSI rates. OBJECTIVE To quantify the risk for CLABSI associated with concurrent use of a second CVC. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included adult patients with 2 or more days with a CVC at 4 geographically separated general acute care hospitals in the Atlanta, Georgia, area that varied in size from 110 to 580 beds, from January 1, 2012, to December 31, 2017. Variables included clinical conditions, central line-days, and concurrent CVC use. Patients were propensity score-matched for likelihood of concurrence (limited to 2 CVCs), and conditional logistic regression modeling was performed to estimate the risk of CLABSI associated with concurrence. Episodes of CVC were categorized as low or high risk and single vs concurrent use to evaluate time to CLABSI with Cox proportional hazards regression models. Data were analyzed from January to June 2019. EXPOSURES Two CVCs present at the same time. MAIN OUTCOMES AND MEASURES Hospitalizations in which a patient developed a CLABSI, allowing estimation of patient risk for CLABSI and daily hazard for a CVC episode ending in CLABSI. RESULTS Among a total of 50 254 patients (median [interquartile range] age, 59 [45-69] years; 26 661 [53.1%] women), 64 575 CVCs were used and 647 CLABSIs were recorded. Concurrent CVC use was recorded in 6877 patients (13.7%); the most frequent indications for concurrent CVC use were nutrition (554 patients [14.1%]) or hemodialysis (1706 patients [43.4%]). In the propensity score-matched cohort, 74 of 3932 patients with concurrent CVC use (1.9%) developed CLABSI, compared with 81 of 7864 patients with single CVC use (1.0%). Having 2 CVCs for longer than two-thirds of a patient's CVC use duration was associated with increased likelihood of developing a CLABSI, adjusting for central line-days and comorbidities (adjusted risk ratio, 1.62; 95% CI, 1.10-2.33; P = .001). In survival analysis adjusting for sex, receipt of chemotherapy or total parenteral nutrition, and facility, compared with a single CVC, the daily hazard for 2 low-risk CVCs was 1.78 (95% CI, 1.35-2.34; P < .001), while the daily hazard for 1 low-risk and 1 high-risk CVC was 1.80 (95% CI, 1.42-2.28; P < .001), and the daily hazard for 2 high-risk CVCs was 1.78 (95% CI, 1.14-2.77; P = .01). CONCLUSIONS AND RELEVANCE These findings suggest that concurrent CVC use is associated with nearly 2-fold the risk of CLABSI compared with use of a single low-risk CVC. Performance metrics (continued) Key Points Question Do current methods to measure performance of central lineassociated bloodstre...

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“…Dube et al 3 are not the first to measure the risk of CLABSI among patients with concurrent catheters; others have also found that concurrent catheters are independently associated with increased CLABSI risk (Table ). [3][4][5][6][7][8][9] Regarding surveillance, adding concurrent CVC days to the denominator reduces the measured incidence of CLABSI. Concurrent CVC days are not accounted for in the US…”

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confidence: 99%

“…Dube et al are not the first to measure the risk of CLABSI among patients with concurrent catheters; others have also found that concurrent catheters are independently associated with increased CLABSI risk (Table). Regarding surveillance, adding concurrent CVC days to the denominator reduces the measured incidence of CLABSI. Concurrent CVC days are not accounted for in the US Centers for Disease Control and Prevention National Healthcare Safety Network; this may partially explain the higher incidence of CLABSI in some tertiary-care academic centers.…”

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How Should Surveillance Systems Account for Concurrent Intravascular Catheters?

Mermel

2020

JAMA Netw Open

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The risk of central venous catheter (CVC)-associated bloodstream infections has decreased dramatically. 1 The same may not be true for infections associated with short-term peripheral venous catheters. 2 The effects of future preventive efforts should be measured using data derived from evidence-based surveillance programs. Dube et al 3 describe a multicenter, retrospective cohort study that assessed the risk of central line-associated bloodstream infection (CLABSI) associated with concurrent CVCs. Analyzing a propensity-adjusted cohort of 11 796 hospitalized patients by status of concurrent CVCs, the authors found that the likelihood of a patient developing CLABSI, after adjustment for confounders, was increased by 62% when they had 2 concurrent CVCs for more than two-thirds of their overall CVC dwell time. In a CVC survival analysis, the daily excess CLABSI risk associated with a concurrent CVC was approximately 80% after adjusting for confounders. Dube et al 3 are not the first to measure the risk of CLABSI among patients with concurrent catheters; others have also found that concurrent catheters are independently associated with increased CLABSI risk (Table). 3-9 Regarding surveillance, adding concurrent CVC days to the denominator reduces the measured incidence of CLABSI. Concurrent CVC days are not accounted for in the US + Related article Author affiliations and article information are listed at the end of this article.

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Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

Cited by 8 publications

References 19 publications

Central line-associated bloodstream infections in patients with COVID-19

Central line-associated bloodstream infections in patients with COVID-19

Comparison of Rates of Central Line–Associated Bloodstream Infections in Patients With 1 vs 2 Central Venous Catheters

How Should Surveillance Systems Account for Concurrent Intravascular Catheters?

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