Trends in Central Line–Associated Bloodstream Infections in a Trauma-Surgical Intensive Care Unit

Abstract

To report the impact of hospital-wide interventions on central line-associated bloodstream infection (CLABSI) rates in a 24-bed trauma-surgical intensive care unit. Data were gathered retrospectively from January 1, 2001, through June 30, 2009. Interventions to reduce CLABSI rates during this period included standardization of line insertion and maintenance processes, development of a mandatory education program incorporating practical line insertion simulation sessions, frequent audits, and intensive care unit staffing modifications. We used the χ(2) test and analysis of variance to analyze the data where appropriate. Urban tertiary referral center providing level I trauma services. Eight thousand four hundred eighty-one trauma-surgical intensive care unit admissions, of which 76% were owing to trauma. During this period, the incidence of CLABSI declined from 6.1 to 0.3 per 1000 line-days. No CLABSIs occurred for 8 of the last 10 quarters (January 2007 to June 2009). Internal jugular sites were associated with a higher CLABSI rate than subclavian sites (P=.03). The central line utilization ratio remained high for most of the study period. When compared with the 2006-2007 Centers for Disease Control and Prevention data, the trauma-surgical intensive care unit was at the 10th percentile in CLABSIs and at the 75th to 90th percentile in central line utilization ratios. The significant decline in the incidence of CLABSIs, which reflected the national trend, could be attributed to multiple interventions. The high central line utilization ratio compared with nationally available data represents a potential target for further improvement.