2098. Reduction of Central-Line-associated Bloodstream Infection Rates: Impact of Minimizing Blood Cultures from Central Lines

Abstract

BackgroundCLABSI surveillance at our institution indicated that a significant proportion of CLABSI had a positive blood culture drawn from central line (CL-BC) with corresponding negative BC done by venipuncture (VP-BC), suggesting possible CL contamination. The contribution of minimizing CL-BC on CLABSI rates remains unknown. This study evaluates the impact on CLABSI rates of reducing CL-BC in addition to standard CLABSI reduction strategies in adult intensive care units (ICUs).MethodsThe study was done from January 1, 2015 to August 31, 2017 in adult ICUs at a hospital with 164 ICU beds, in urban Detroit. Education initiatives to minimize CL-BC were implemented in the ICU. Internal metrics VP-BC ratio (No. VP-BC/total BC in patients with CL) and CL-BC ratio (No. CL-BC/total BC in patients with CL) were used to monitor effectiveness. Compliance audits of CL maintenance were done, i.e., CL dressing intact, proper use of chlorhexidine dressing, site without redness or drainage. Monthly unit-specific CLABSI rates, CL utilization ratios (CL-UR), and VP-BC and CL-BC ratios were provided as feedback to the ICUs. CLABSI rates and number of contaminated BC were monitored. Trends of the various metrics were analyzed using Kendall Tau’s correlation for continuous variables. The relationship between CLABSI rate, VP-BC ratios and CL-UR were examined using Spearman’s correlation coefficient. Statistical significance was set at P < 0.05.ResultsDuring the study period in the ICU there were 148,762 patient-days and 82,153 CL days. Trends over time of the metrics are shown (figure). There was significant improvement noted in CLABSI rates, CL-UR and VP-BC rates (Table 1). There was a significant correlation between the CLABSI rates with VP-BC −0.395 (P value = 0.025) and a not significant correlation with CL-UR 0.278 (P value = 0.123). The number of contaminated blood cultures were 29, 3, and 0 in 2015, 2016 and 2017, respectively.ConclusionMinimizing BC obtained from CL can significantly contribute to reduction in CLABSI rates when used in combination with standard best care practices for CL insertion and maintenance.Table 1:Correlation of Metrics Over TtimeVariableCorrelation with Time P-ValueCLABSI rate−0.2600.036CL-UR−0.520<0.001VP-BC ratio0.806<0.001CL care bundle compliance−0.0480.805 Disclosures All authors: No reported disclosures.