Central Line-Associated Bloodstream Infections and Ventilator-Associated Events in the Intensive Care Unit

Abstract

Central line–associated bloodstream infections (CLABSIs) and ventilator-associated events (VAEs) are among the most prevalent and morbid health care–associated infections (HAIs) encountered in the ICU. The past decade has seen concerted efforts to reduce the cost of these infections, both fiscal and physical, but the evidence underlying these efforts varies in quality. Whereas the data supporting interventions to reduce CLABSI are robust and reproducible, the evidence for ventilator-associated pneumonia has suffered from inconsistencies. CLABSIs are well defined, may be confirmed by laboratory testing, and are amenable to active surveillance programs. In contrast, the clinical definition of ventilator-associated pneumonia lacks specificity and the diagnosis is confounded by inter-observer variability, thus complicating efforts to reduce its prevalence. In this context, we review recommendations for reducing these HAIs, and describe efforts to standardize surveillance definitions for VAE. These interventions are presented alongside our institution’s 5-year CLABSI and VAE data with notes on our changing practice over time. As intensivists, enacting current practice recommendations are among the best available measures to limit the incidence of HAIs in our ICUs.