Central Line-related Bloodstream Infection Research Articles

Hospital-Acquired Bloodstream Infections in the Adult Intensive Care Unit at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia.

Introduction Hospital-acquired infections, also called nosocomial infections, are infectious diseases acquired in healthcare facilities at least 48 hours after admission and can't be present at the time of admission. Nosocomial bloodstream infection is a serious medical complication from hospitalization, and it can be potentially preventable by taking certain precautions. Aim The aim of this study is to determine the prevalence of central line-related bloodstream infections (CLABSI) with different organisms between January 2022 and February 2024 at the intensive care unit (ICU) at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia. Patients and methods This retrospective cross-sectional study was conducted among ICU adult patients. The data were collected from medical and infection control records. All data for intensive care patients with positive blood cultures, except for the pediatric age group, were collected. Data were tabulated and cleaned in MS Excel, and subsequent data analyses were performed in IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results Data from 21 patients were collected and analyzed. The mean age of the participants was 62.9 (SD 15.1) years.Femaleparticipants (61.9% (13)) were higher than males(38.1% (8)). All patients were inserted with a non-tunneled central venous catheter (CVC). The mortality rate was 76.2% (16). Vancomycin-resistant enterococci (VRE) was the most commonly detected organism in seven cultures(33.3%), followed by Candida species in six cultures(28.6%). Candida species were prevalent in younger patients (p=0.021) and those sensitive to medication (p=0.015). Survival analyses between age, gender, and organisms yielded insignificant results (p>0.05). Conclusion The major sources of bloodstream infection among adult ICU patients were VRE and Candida species. Mortality was common in this population, particularly among patients who were resistant to medication. Hence, strategies to reduce hospital-acquired bloodstream infections are warranted.

Catheter salvage from central line-related bloodstream infections in pediatric intestinal failure.

Patients with intestinal failure require central venous access which puts them at risk for central line-associated bloodstream infections (CLABSI). Maintaining vascular patency is critical for this population to receive nutrition support. When CLABSIs occur line salvage can help maintain vascular access. The aim of this study is to assess factors associated with safe and successful central venous catheter salvage. Retrospective cohort study of patients with intestinal failure at two tertiary care institutions between 2012 and 2020. The study examined the rates of attempted salvage, factors associated with successful salvage, and complications associated with salvage attempts. Over the study period, 76 patients with intestinal failure were include while central venous access was in place. There were a total of 94 CLABSIs. Salvage was more likely to be attempted when patients were under the direct care of an intestinal rehabilitation service (95% vs. 68%, p = 0.04). The overall successful salvage rate was 91.6% (n = 77). Gram-positive, Gram-negative, and polymicrobial infections had successful salvage rates of 97%, 92%, and 94% respectively. The successful salvage rate for fungal infections was 40%. There was no difference in 30-day complication rates for hospital readmission, intensive care unit admission, and death between patients who underwent salvage attempt and those who did not. Central line salvage can be safely attempted for many infections in patients with intestinal failure, leading to vascular access preservation.

The evaluation of Candida-related central line-related bloodstream infections in pediatric cancer patients: A pre- and post-intervention study.

The purpose of this study was to assess the efficacy of a central line maintenance bundle in preventing catheter-related (implanted venous access devices, port) Candida bloodstream infections. The study encompassed two distinct time periods, namely, pre-bundle and bundle. The number of catheter-related bloodstream infections (CRBSI) episodes per catheter days for each timeframe was determined. Upon implementation of the central line bundle, the rate of CRBSI reduced significantly from 4.27 per 1000 central line days in the pre-bundle period to 1.0 per 1000 central line days in the bundle period (p < .001). Using a central line bundle to avoid CRBSIs in pediatric cancer patients with ports led to a significant decrease in Candida species-related CRBSIs.

Incidence and short-term outcomes of central line-related bloodstream infection in patients admitted to the emergency department: a single-center retrospective study

Central line-related bloodstream infection (CRBSI) is a common complication during hospital admissions; however, there is insufficient data regarding CRBSI in the emergency department. Therefore, we evaluated the incidence and clinical impact of CRBSI using a single-center retrospective study to analyze medical data of 2189 adult patients (median age: 65 years, 58.8% males) who underwent central line insertion in ED from 2013 to 2015. CRBSI was defined if the same pathogens were identified at peripheral and catheter tips or the differential time to positivity was > 2 h. CRBSI-related in-hospital mortality and risk factors were evaluated. CRBSI occurred in 80 patients (3.7%), of which 51 survived and 29 died; those with CRBSI had higher incidence of subclavian vein insertion and retry rates. Staphylococcus epidermidis was the most common pathogen, followed by Staphylococcus aureus, Enterococcus faecium, and Escherichia coli. Using multivariate analysis, we found that CRBSI development was an independent risk factor for in-hospital mortality (adjusted odds ratio: 1.93, 95% confidence intervals: 1.19–3.14, p < 0.01). Our findings suggest that CRBSI after central line insertion in the emergency department is common and associated with poor outcomes. Infection prevention and management measures to reduce CRBSI incidence are essential to improve clinical outcomes.

A Correlational Study to Assess the Knowledge and Practices Regarding Central Line-Associated Bloodstream Infection Care Bundle among the Staff Nurses in Selected Hospitals of Maharashtra in View to Prepare the Multi Modular Learning Tool

The aim of this research is to assess the level of knowledge held by staff nurses in relation to the central line-associated bloodstream infection care bundle as well as their actions. The investigator chose to use a descriptive survey approach with descriptive study design and to investigate the staff nurses’ knowledge of and behaviors relating to the central line-related bloodstream infection treatment package. The sample consisted of 125 registered nurses who were working in the intensive care unit of the hospital. For this investigation, a non-probability purposeful sampling strategy was utilized to select the sample. The analysis of the information included both descriptive and inferential statistical methods. The Karl Pearson correlation coefficient test and the Chi-square test used to refer to examine the correlation and determine the relationship between knowledge and practice about the treatment of bloodstream infections linked with central lines and demographic factors. The findings of this investigation demonstrated that 79 (63.2%) had inadequate knowledge followed by 38 (30.4%) had moderate knowledge and 8 (6.4%) had adequate knowledge regarding central line-associated bloodstream infection (CLABSI) care bundle. Seventy-five (60%) had poor level of practices, 40 (32%) had average level of practices, and 10 (8%) had good level of practices regarding CLABSI care bundle, there is positive correlation that was identified between knowledge and practices, that is, (r = 0.7501). According to the results of this investigation, staff nurses had knowledge and practices about the care bundle for central line-related bloodstream infections that were on average appropriate. Investigator recommends that the distribution of the multi modular learning tool addressing the central line-related bloodstream infections care bundle, both the knowledge, and the practices will be enhanced.

The effect of an intervention bundle to prevent central venous catheter-related bloodstream infection in a national programme in the Netherlands

Central venous catheters (CVCs) can lead to central line-related bloodstream infections (CRBSIs). A six-item bundle was introduced in 2009 to prevent CRBSI in Dutch hospitals. This study aimed to determine the impact of an intervention bundle on CRBSI risk. Data were obtained from hospitals participating in the national CRBSI surveillance between 2009 and 2019. Bundle compliance was evaluated as a total ('overall') bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks). We estimated the impact of the overall and partial bundles, using multi-level Cox regression. Of the 66 hospitals in the CRBSI surveillance 56 (84.8%) recorded annual bundle (non)compliance for >80% of the CVCs, for one to nine years. In these 56 hospitals CRBSI incidence decreased from 4.0 to 1.6/1000 CVC days. In the intensive care units (ICUs), compliance was not associated with CRBSI risk (hazard ratio (HR) for the overall, insertion and maintenance bundle were 1.14 (95% confidence interval 0.80-1.64), 1.05 (0.56-1.95) and 1.13 (0.79-1.62)), respectively. Outside the ICU the non-significant association of compliance with the overall bundle (HR 1.36 (0.96-1.93)) resulted from opposite effects of the insertion bundle, associated with decreased risk (HR 0.50 (0.30-0.85)) and the maintenance bundle, associated with increased risk (HR 1.68 (1.19-2.36)). Following a national programme to introduce an intervention bundle, CRBSI incidence decreased significantly. In the ICU, bundle compliance was not associated with CRBSI risk, but outside the ICU improved compliance with the insertion bundle resulted in a decreased CRBSI risk.

Impact of a change in universal gloving protocol on rates of central line-related bloodstream infection, Clostridioides difficile, and vancomycin-resistant Enterococcus

In this retrospective cohort of adult hematology-oncology and transplant patients, discontinuation of universal gloving did not result in significant changes in rates of central line-associated bloodstream infection, Clostridioides difficile infection, or vancomycin-resistant Enterococcus colonization. Active surveillance and subsequent isolation may be a viable alternative strategy to universal precautions.

The effect of the multimodal intervention including an automatic notification of catheter days on reducing central line-related bloodstream infection: a retrospective, observational, quasi-experimental study

BackgroundA central venous catheter (CVC) is an important medical device, but it could be preceding infection and the risk of central line-associated bloodstream infection (CLABSI). CLABSI is a common healthcare-associated infection but results in high cost and mortality; therefore, various efforts to reduce CLABSI have been attempted.MethodsThis is a retrospective, observational, quasi-experimental study in the intensive care unit (ICU) of a single tertiary care hospital. We reviewed and analysed the data of CLABSI rates and days from the insertion to the removal of the temporary CVC between January 2018 and June 2021 with transient periods over 9 months. Sequentially, all patients with the CVC in the ICU underwent the following interventions: maximal barrier precaution, automatic notification of catheter days and 2% chlorhexidine gluconate bathing. A segmented regression analysis of interrupted time series was conducted to compare the CLABSI rates before and after the introduction of multimodal interventions. During study periods, the impact of interventions on CLABSI was evaluated using multivariate logistic regression analyses.ResultsA total of 76,504 patient-days, 28,312 catheter days and 66 CLABSI cases were reviewed in ICU-hospitalised patients. As additional interventions, the CLABSI rate declined from 3.1 per 1000 CVC days to 1.2 per 1000 CVC days in post-interventions. In the pre-intervention and post-intervention periods, 4146 patents had one more short-term CVC. In the multivariate logistic regression analyses, multimodal intervention was one of determinants reducing CLABSI rates (odds ratio (OR), 0.52 [95% confidence interval {CI}, 0.28–0.94]). Indwelling time of CVC over 10 days was the risk factor for CLABSI rates (OR, 6.27 [95% CI, 3.36–12.48]). Of the three interventions, the automatic notification of catheter days was associated with decreased median monthly total CVC days and duration of CVC days per patient.ConclusionsMultidisciplinary and evidence-based interventions could lead to a decrease in the CLABSI rates. Moreover, the automatic notification of catheter days of the electronic medical healthcare system has shortened the time of indwelling CVC.

Central line-associated bloodstream infection (CLABSI) with three different vascular access in neonatal intensive care unit

BackgroundCentral venous catheters (CVCs) are a mandatory aspect in the neonatal intensive care units. Unfortunately, bloodstream infection is a frequent complication of CVCs. A needleless connector is attached to the end of CVC to allow infusion of fluids. We aimed to assess the effect of needleless connectors on central line-associated blood stream infection, and to assess rate of occurrence of bloodstream infection with the use of three different types of venous access in neonates.MethodsThis study is a prospective, randomized, comparative study which was held at the Neonatal Intensive Care, Faculty of Medicine, Ain Shams University. The study recruited 120 neonates who were categorized into three groups according to the type of inserted CVC: group A with umbilical venous catheter, group B with peripherally inserted central catheter, and group C with non-tunneled central venous catheter, and each group was further subdivided into two groups according to the use of needleless connector. Criteria of central line-associated bloodstream infection (CLABSI) and central line-related bloodstream infection (CLRBSI) were applied.ResultsThe study included 120 neonates, a multivariable logistic regression analysis was held for two predictors (type of CVC and use of needleless connector) of CLABSI/CLRBSI, it revealed that the use of needleless connector was associated with significant lower incidence of CLABSI/CLRBSI (P value < 0.05, adjusted odds ratio [aOR] = 0.303), the use of peripheral inserted central catheter (PICC) was also associated with the lowest incidence of CLABSI/CLRBSI (P value = 0.015, aOR = 0.284). Another multivariable logistic regression analysis was done for four predictors (type of CVC, use of needleless connector, gestational age, and catheter dwell time) which revealed that the gestational age (P value = 0.001, aOR = 0.691) and catheter dwell time (P value = 0.004, aOR = 1.313) were the only independent predictors for the occurrence of CLABSI/CLRBSI.ConclusionThe use of needleless connector can lower the incidence of CLABSI/CLRBSI, PICC line was associated with the lowest incidence of CLABSI/CLRBSI among the three types of CVCs. Low gestational age and long catheter dwell time were found to be the main risk factors for increasing the incidence of CLABSI/CLRBSI.

Understanding Preventable Deaths in the Geriatric Trauma Population: Analysis of 3,452,339 Patients From the Center of Medicare and Medicaid Services Database.

Patient safety indicators (PSIs) are avoidable complications that can impact outcomes. Geriatric patients have a higher mortality than younger patients with similar injuries, and understanding the etiology may help reduce mortality. We aim to estimate preventable geriatric trauma mortality in the United States and identify PSIs associated with increased preventable mortality. A retrospective cohort study of patients aged ≥65 years, in the CMS database, 2017-second quarter of 2020. Risk-adjusted multivariable regression was performed to calculate observed-to-expected (O/E) mortality ratios for failure-to-prevent and failure-to-rescue PSIs with significance defined as P < .05. 3 452 339 geriatric patients were analyzed. Patients aged 75-84 years had 33% higher odds of preventable mortality (adjusted odds ratio [aOR] = 1.33 and 95% confidence interval [CI] = 1.31, 1.36), whereas patients aged ≥85 years had 91% higher odds of preventable mortality (aOR = 1.91 and 95% CI = 1.87, 1.94) compared to patients aged 65-74 years. Failure-to-prevent O/E were >1 for all PSIs evaluated with central line-related blood stream infection having a high O/E (747.93). Failure-to-rescue O/E were >1 for 10/11 (91%) PSIs with physiologic and metabolic derangements having the highest O/E (5.98). United States' states with higher quantities of geriatric trauma patients experienced reduced preventable mortality. Odds of preventable mortality increases with age. Perioperative venous thrombotic events, hemorrhage or hematoma, and postoperative physiologic/metabolic derangements produce significant preventable mortalities. United States' states differ in their failure-to-prevent and failure-to-rescue PSIs. Utilization of national guidelines, minimization of central venous catheter use, addressing polypharmacy especially anticoagulation, ensuring operative and procedure-based competencies, and greater incorporation of inpatient geriatricians may serve to reduce preventable mortality in elderly trauma patients.

Antibiotic stewardship in a tertiary care NICU of northern India: a quality improvement initiative

BackgroundThe overuse of antibiotics in newborns leads to increased mortality and morbidities. Implementation of a successful antibiotic stewardship programme (ASP) is necessary to decrease inappropriate use of antibiotics and its...

Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients?

Background The use of indwelling central venous access devices (CVADs) in children can result in complications such as infection, occlusion, and dislodgement.Purpose To evaluate whether reinforcing CVAD care bundles by using a regular direct feedback system could reduce such complications in children.Methods The intervention in this retrospective interrupted time-series study was initiated in January 2019. The study was divided into the preintervention (October–December 2018), 3-month postintervention (January–March 2019), and 6-month postintervention (April–June 2019) phases. Risk difference and Poisson regression analyses were used to illustrate the effectiveness of the intervention.Results The hospital-wide central line-related bloodstream infection rate decreased from 10.0/1,000 catheter-days to 4.5/1,000 catheter-days at 3-month postintervention (P=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (P=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (P=0.04) and 8.3% (P=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (P=0.364) and 3.3% (P=0.378) at 3 and 6 months, respectively.Conclusion Reinforcing CVAD care bundles with direct feedback could significantly decrease CVAD-associated complications in terms of infection at 6-month postintervention, and occlusion at 3- and 6-month postintervention. Thus, reinforcement and regular direct feedback might improve care quality in children with CVADs.

Central line-related bloodstream infections and microbiological study in an Egyptian Ministry of Health Hospital.

Central line-associated bloodstream infections continue to be one of the most important health problems in ICU. To identify the central line-related bloodstream infections and their microbiological characteristics Specific objectives to the identify the incidence, predisposing factors of central line-related bloodstream Infections and study the antibiotic sensitivity patterns of the isolated organisms. Patients' demographic, clinical data, central venous catheter related data,and blood culture specimen collection data were collected utilizing a descriptive exploratory design from a purposive sample of 120 ICU patients underwent insertion central venous catheter. out of 120 central line catheters sent for culture from patients immediately and seven days after insertion., 13(10.83%) were positive seven days after insertion. Of the 13 infection cases, 10 cases were Staphylococcus epidermis and the others were Staphylococcus aureus. In addition, most infected patients were overweight and obese, diabetic, had sub-clavian route, and their length of hospital stayed more than7 days. 10.83 % developed bacterial blood stream infection 7 days after insertion of central venous catheters, and most of bacterial isolates were Staphylococcus epidermis and were sensitive to Vancomycin and Amikain.

Improvement in the Diagnosis of Patients With Central Line-Related Bloodstream Infections by Proper Blood Culture Drawing and Labeling in an Emergency Center

Improvement in the Diagnosis of Patients With Central Line-Related Bloodstream Infections by Proper Blood Culture Drawing and Labeling in an Emergency Center

Effect of Early Removal of Central Catheterization in Febrile Neutropenic Patients with Acute Leukemia

Background: A guideline of central line-related blood stream infection (CRBSI) is only for immune-competent patients with end-stage renal disease on hemodialysis. We need widely acceptable guideline whether remove or maintain a central catheter in febrile neutropenic patients.Method: Medical records from 293 cases (95 patients) of febrile neutropenia with Central Catheterization were obtained retrospectively, and clinical characteristics, particularly duration of fever, were analyzed according to the early removal of central catheterization under anti-cancer chemotherapy for acute leukemia.Results: Forty-eight cases (16.4%) have already baseline fever and 25 cases (8.5%) showed baseline pneumonic infiltration prior to chemotherapy. The insertion sites of catheterization were subclavian (85.3%), internal jugular (12.6%), and others (2.0%). Early removal of central catheter was done at 93 cases (31.7%) and the cause of early removal was fever (63.4%), malfunction (11.8%), and others (24.7%). The duration of fever was significantly shortened by early removal of central catheterization (5.4 vs 7.5 days, P =0.003, Figure 1A). In addition, the duration of fever was related with age, diagnosis, type of chemotherapy, presence of baseline fever or pneumonic consolidation in univariate analysis. The site of central access or body mass index as well as existence of CRBSI did not affect duration of fever. In multivariate analysis, early removal of central catheter was independently associated with short duration of fever (OR=0.619, 95% CI=0.46-0.83, P =0.001, Table 1). The effect of early removal of central catheter was highlighted when micro-organisms were documented (Figure 1B).Summary: In patients with febrile neutropenia, early removal of central catheter can shorten the duration of fever particularly when BSI was documented. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

No evidence of benefit from antibiotic lock therapy in pediatric oncology patients with central line-related bloodstream infection: results of a retrospective matched cohort study and review of the literature.

Long-term central venous catheters (CVCs) are essential to modern pediatric oncology practice, but central line-related bloodstream infection (CRBSI) is a frequent and important complication. CVC salvage is often attempted but treatment failure is common due to persistent infection, delayed catheter removal, or subsequent relapse of infection, which can be associated with significant morbidity and cost. Adjunctive antibiotic lock therapy (ALT) has been proposed to reduce the risk of treatment failure, but insufficient data are available to confirm efficacy of this intervention. We undertook a retrospective matched cohort study of ALT use for treatment of CRBSI in pediatric hematology/oncology patients at St. Jude Children's Research Hospital between 2006 and 2012. Thirty-eight eligible episodes of CRBSI treated with adjunctive ALT were identified and compared to 73 episodes treated with standard therapy (ST) alone, matched by catheter-type and organism. Overall, treatment failure was similar between ALT and ST groups (50.0 vs. 38.4%; P = 0.24), but the timing was different; in the ALT cohort, immediate CVC removal was less common (0.0 vs. 12.3%; P = 0.03) but delayed removal (4-13 days) and relapse of infection was more common (50.0 vs. 24.7%; P = 0.01). This retrospective study was unable to identify any benefit of adjunctive ALT in pediatric oncology patients with CRBSI. The available evidence does not support routine ALT use, and well-conducted prospective studies are needed.

Essential Components of an Infection Prevention Program for Outpatient Hemodialysis Centers

Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central line-related bloodstream infections occurred in hemodialysis patients in 2008 and dialysis-associated outbreaks of hepatitis C continue to be reported. While established hospital-based infection prevention programs have existed since the 1970s, few dialysis facilities have an established in-center program, unless the dialysis facility is hospital-associated. This review focuses on essential core components required for an effective infection prevention program, extrapolating from acute-care programs and building on current dialysis guidelines and recommendations. An effective infection prevention program requires infrastructure, including leaders who place infection prevention as a top priority, active involvement from a multidisciplinary team, surveillance of outcomes and processes with feedback, staff and patient education, and consistent use of evidence-based practices. The program must be integrated into the existing Quality Assessment and Performance Improvement program. Best practice recommendations for the prevention of infection, specific to dialysis, continue to evolve as the epidemiology of dialysis-associated infections is further researched and new evidence is gathered. A review of case studies illustrates that with an effective program in place, infection prevention becomes part of the culture, reduces infection risk, and improves patient safety.

Chlorhexidine Gluconate

Despite infection-prevention initiatives, hospital-acquired infections (HAIs) are still a common occurrence. Chlorhexidine gluconate (CHG) is an important antibacterial agent. Research indicates that the intervention of bathing with CHG can reduce the number of HAIs. Chlorhexidine gluconate is known to reduce the bioload of several bacteria, including multiple strains of methicillin-resistant Staphylococcus aureus. Research regarding the intervention of bathing with CHG was assessed and found to reduce central line-related blood stream infections, ventilator-associated pneumonia, and vancomycin-resistant enterococci. The reduction in HAIs was found to be greater as compared to bathing with soap and water. The reduction of these HAIs will allow for a saving of resources, finances and staff time, which may ultimately be passed on to the patient. While further research is indicated, a strong conclusion is drawn that bathing with CHG reduces the number of HAIs.

Evolution of Critical Care Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the Emerging Need for New Medical Staffing and Training Models

Critical care, defined as the diagnosis and management of life-threatening conditions that require close or constant attention by a group of specially trained health professionals, is inherent to the practice of cardiovascular medicine. The demand for cardiovascular critical care is increasing with the aging of the population and is reflected by trends in the use of critical care in general.1 Between 2000 and 2005, although the total number of hospital beds in the United States declined by 4.2%, the number of critical care beds increased by 6.5% and the annual costs attributed to critical care increased by 44%, representing 13.4% of hospital costs.2 Projections for the next 15 years suggest that the need for critical care will increase markedly in the United States and globally.1,3–5 For example, in Canada, a 57% increase in the need for critical care beds is anticipated during that period.5 Concurrent with increases in demand, the medical demographics of general and cardiac critical care have evolved toward a patient population with an increasing number of comorbid medical conditions who require more prolonged and more technologically sophisticated invasive support. As a result, the delivery of critical care is advancing substantially in its complexity. Moreover, accumulating evidence has indicated that outcomes are better when critical care is provided by specially trained providers in a dedicated intensive care unit (ICU).6–9 In the context of this evolution, provision of optimal care in the contemporary cardiac ICU (CICU) presents a different set of challenges and requires an expanded set of skills compared with 10 years ago. Cardiovascular medicine has lagged behind other medical disciplines that have met the “critical care crisis”4 with ICU-focused innovations in organization, training, and quality improvement. Therefore, the American Heart Association Council on Cardiopulmonary, Critical …

The Challenges in Implementing a Central Line Related Bloodstream Infection (CLABSI) Prevention Outside the ICU through a Multihospital Collaborative

Prevention collaboratives have been successful in reducing CLABSI rates in ICUs by focusing on education, physician champions and multidisciplinary implementation of central line insertion bundle. Surveillance and prevention outside the ICU may require a different approach with nurses playing a key role. We describe the challenges encountered in a collaborative project to reduce CLABSI outside the ICU.