CLABSI can be prevented through proper insertion techniques and management of the central line . These techniques are addressed in the CDC ’ s Healthcare
Infection Control Practices Advisory
Committee ( CDC / HICPAC ) Guidelines for the Prevention of Intravascular
Catheter-
Related Infections , 2011 , as well as in the
Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care
Hospitals : 2014 Update .
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Q experienced the second highest increase ( 13 percent ). Critical-care locations had the highest number of CLABSIs in 2020 Q2 , with 1,911 events . Hospitals in all bed size categories experienced an increase in SIR .
The researchers found that in 2020 Q2 , reporting of CLABSI surveillance dropped by 17 percent nationally , in contrast with 2019 Q2 . The greatest decrease in reporting ( 48 percent ) occurred in the Middle Northeast . Regional analysis showed significant percent changes in the SIR from 2019 to 2020 in seven regions ( Upper Northeast , Lower Northeast , Southeast , Great Lakes , Northern Plains , West , and Northwest , regions ). The highest regional 2020 Q2 SIR was 1.07 and occurred in the Upper Northeast , representing a 45 percent increase compared to 2019 Q2 .
Evaluating by ward-type , pediatric medical-surgical wards contributed 4 percent of the national central line days from ward locations in 2020 Q2 and had the greatest change in their SIR ( 118 percent increase ). Statistically significant increases in the SIR also occurred in medical critical care ( 60 percent ), medical-surgical critical care ( 59 percent ), and neurosurgical critical care ( 108 percent ). In addition , the device utilization ratio increased in pediatric medical-surgical wards from 0.14 ( 2019 ) to 0.18 ( 2020 ).
Margaret Dudeck , a public health analyst with CDC ’ s National Healthcare Safety Network , says , “ This paper focused on consistent reporters for a three-month time period which aligned with the early months of the COVID-19 pandemic in the United States . Based on the information reported to NHSN by these consistent reporters , the observed increases in the CLABSI SIRs during this time period , compared to the previous year , are due to an increase in the number of infections observed . The number of line insertions and length of time in which lines are in place ( i . e ., central line days ) does increase the risk of a CLABSI . This risk is affected by other factors related to the patient ’ s care during their hospitalization , including line insertion practices and line maintenance . At this time , it ’ s too early in the year to predict how the ongoing threat of the pandemic may impact the risk and incidence of CLABSIs in acute-care hospitals in 2021 .”
The researchers acknowledge that , “ Consistent with the concern that
CLABSIs : A Real-World Perspective From the Trenches
Healthcare Hygiene magazine spoke with Michelle DeVries , MPH , CIC , VA-BC , senior infection control officer at Methodist Hospitals , regarding the recent ICHE paper looking at COVID-19 ’ s impact on CLABSI rates .
& A
HHM Regarding the decrease in CLABSIs 2015-2019 , and then the uptick especially late 2019 and early 2020 – do you think this is because of increased / better surveillance , coding , and other factors , or because there really were more infections ? What are you seeing out there ?
Michelle DeVries ( MD ): I haven ’ t seen anything to suggest that surveillance for device-associated infections increased during the early COVID experience ; in fact , based on the ICHE article there was a decrease in hospitals who were reporting any data on this . Even with the limitations presented in the paper , I do believe that the increases are consistent with what others have reported about the actual incidence of infection going up . I presented a webinar recently , and in the poll ( non-scientific survey ) 40 percent of attendees reported that their CLABSI rates went up last year .
HHM It makes sense that COVID-19 would trigger an increase in line insertions and therefore an increase in infections ; is this flawed logic , and do we automatically have to accept that the numbers of infections go up when the number of lines goes up ?
MD : Central line utilization was high for critically ill patients ; the analysis in the article captures a measurable increase in this utilization as well . It is worth noting though that data is only reported on a subset of units , and may not have captured the full burden which the authors acknowledge . For instance , as we developed COVID cohort units in my organization , these were all “ new ” units in NHSN so would have been excluded from the analysis for that reason as well as because they are stepdown units , so excluded from what the article captured . Increases in central line utilization do increase the risk of infection which is why every evidence-based recommendation includes daily review of line necessity in some manner as part of the risk reduction . When central line usage is the indicated based on patient needs , we need to ensure that our insertion , care and maintenance activities are scrupulous , to keep the inherent risks as low as possibly achievable . What the country experienced with COVID made that a difficult undertaking .
HHM As the ICHE paper reports that critical-care units had the greatest percentage increase in SIR , followed by ward locations . Any insights to share ?
MD : I would have been interested to see the impact on critical care stepdown units as well , but that is excluded