Burden and epidemiology of CLABSIs in non-ICU settings: implications for an infection prevention program

Ms Gillian Land1, Ms Pauline Bass1, Ms Kerrie Watson2, Associate Professor  Leon Worth1

1Alfred Health Infection Prevention and Healthcare Epidemiology, Melbourne, Australia,
2Alfred Health Infectious Diseases Data Unit, Melbourne, Australia

Background:

Prevention of central line-associated bloodstream infections (CLABSI) in ICUs has become a priority in Australia, with ICU CLABSI events often used as quality indicators. In 2006, a hospital-wide CLABSI monitoring and prevention program was implemented at our facility. The objective of this study was to compare ICU and non-ICU burden of illness, and to describe epidemiology of non-ICU CLABSI events.

Method:

Standardised surveillance definitions based upon CDC/NHSN were applied consistently throughout the period 1 Jan 2015 to 31 December 2018, including exclusion of events related to mucosal barrier injury. Denominator data were captured for ICU and the haematology ward.

Result:

In total, 180 CLABSI events were observed hospital-wide, with 18 (10%) in ICU and 162 (90%) in non-ICU wards. Of non-ICU CLABSI events, the majority (112, 62.2%) occurred in haematology patients, with fewer in burns (10) and nephrology (5) populations. Overall CLABSI rates in ICU and haematology populations were 0.45 and 3.36/1000 CVC days, respectively. Of non-ICU infections due to a single organism, the most frequent pathogens were: Pseudomonas sp. (21.0%), Klebsiella sp. (11.3%) Stenotrophomonas sp. and Candida sp. (9.7% each).

Conclusion:

The majority of CLABSI events (90%) occur outside of ICU settings in immunocompromised patient populations, with a large proportion due to gram-negative pathogens. Successful ICU prevention bundles must be evaluated to determine relevance to other specialised clinical departments, where dedicated resources are also required to ensure that standardised monitoring is performed.


Biography:

Gillian was a primary school teacher for five years prior to commencing nursing training at the Royal Children’s Hospital in Melbourne in 1981.

Gillian worked overseas for several years, returned to complete an Emergency Nursing Certificate, and worked in the Trauma/Emergency and Haematology/Oncology Units at Alfred. Gillian commenced employment as the Infection Control Education/Orientation nurse for Alfred Hospital Bayside Health in 2001 and completed her Certificate in Sterilisation and Infection Control in 2006. Her current portfolios includes ICU and hospital wide CLABSIs which is one of her main interests.

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