Central line-associated bloodstream infection (CLABSI) in Cancer patients: Role of Central Line Insertion Practices and Audit System in prevention

Dr Hitender Gautam1, Dr Abdul Hakim Choudhary2, Dr Sarita Mohapatra3, Dr Seema Sood3, Dr Bimal Kumar Das3, Dr Arti Kapil3

1Infection Control Officer, Dr. BRA IRCH & Department of Microbiology, AIIMS, Ansari Nagar, Delhi, India

2Department of Hospital Administration, AIIMS, Ansari Nagar, Delhi, India

3Department of Microbiology, AIIMS, AIIMS, Ansari Nagar, Delhi, India


Central venous catheters(CVCs) are essential component for care of cancer patients. Deadly cost of CLABSIs is prolonged hospitalization, increased hospitalization costs and mortality. In India, CLABSI rate (2.5) were significantly higher than CDC/NHSN thresholds(1.02). In Cancer Units, CLABSI rate was 5.2 & 5.86 per 1,000 central-line days from Brazil and Canada respectively

Prospective CLABSI surveillance study (CDC/NHSN criteria) with microorganisms isolated and their anti-microbial susceptibility status from tertiary-care centre, Dr. BRA IRCH, Cancer Division, All India Institute of Medical Sciences (AIIMS), New Delhi. Study period from October-2016 to December-2017. Initially, only CDCs Central-Line-Insertion-Practices (CLIP) educational activity was performed. Audit of the infections control activity was performed in July-2017

There were 52,467 patient-days and 8,842 central-line days. Mean device utilization rate (DUR) was 0.22 and mean CLABSI rate, 5.73 per 1,000 central-line days. Immediately Post CLIP audit, CLABSI rate was reduced, but it came back to average CLABSI rate in following months. Among the CLABSI cases, 38% were Klebsiella pneumoniae(85% ESBL), 15% were Acinetobacter baumanii(36% resistance to Carbapenem), 14% were Pseudomonas aeruginosa, 10% were Escherichia coli(75% ESBL) & 9% were Enterococcus spp.

CLABSI rate of Cancer Unit in India (5.73) was similar to rates from Brazil (5.2) & Canada (5.8). Most organisms isolated were gram-negative with Klebsiella spp. being predominant (85% ESBL and 30% Carbapenem resistant), more so a motive to reduce CLABSIs. Most CLABSI prevention interventions have concentrated on CVC insertion process. CLIP educational activity should be accompanied with continuous audit system & broader inter-professional approach


Dr. Hitender Gautam is currently the Hospital Infection Control Officer for Dr. BRA IRCH, Cancer Division of Premiere Medical School of India, AIl India Institute of Medical Sciences (AIIMS), New Delhi. He is working as Assistant Professor in the Department of Microbiology. He has also worked as Hospital Infection Control Officer at JIPMER, Pondicherry, India, One of the health institute of National Importance In India. He was member Hospital Infection Control Committee and Consultant for Communicable Disease Control at Ist Public NABL Pediatric Hospital in India.

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