Emergency Department Central Line-associated Bloodstream Infections (CLABSI) Incidence in the Era of Prevention Practices

Objectives: The incidence of central line-associated bloodstream infections (CLABSI) attributed to central venous catheters (CVCs) inserted in the emergency department (ED) is not widely reported. The goal was to report the incidence of ED CLABSI. Secondary goals included determining the effect of a CVC bundle introduced by the hospital infection prevention department to decrease CLABSI during the surveillance period.

Methods: This was a prospective observational study over a 28-month period at an academic tertiary care center. A standardized electronic CVC procedure note identified CVC insertions in the ED. Abstractors reviewed inpatient records to determine ED CVC catheter-days. An infection prevention specialist identified CLABSIs originating in the ED using National Hospital Safety Network definitions from blood culture results collected up to 2 days after ED CVC removal. During the period of surveillance, a hospital-wide CVC insertion bundle was introduced to standardize insertion practices and prevent CLABSIs. Institutional CLABSI rates were determined by infection prevention from routine surveillance data.

Results: Over the 28-month study period, 98 emergency physicians inserted 994 CVCs in 940 patients. The ED CVCs remained in place for more than 2 days in 679 patients, and the median number of days an ED CVC remained in use during the hospital stay was 3 (interquartile range = 2 to 7 days). There were 4,504 ED catheter-days and nine CLABSIs attributed to ED CVCs. The ED CLABSI rate was 2.0/1,000 catheter-days (95% confidence interval [CI] = 1.0 to 3.8). The concurrent institutional intensive care unit (ICU) CLABSI rate was 2.3/1,000 catheter-days (95% CI = 1.9 to 2.7). The ED CLABSI rate prebundle was 3.0/1,000 catheter-days and postbundle was 0.5/1,000 catheter-days (p = 0.038).

Conclusions: The CLABSI rates in this academic medical center ED were in the range of those reported by the ICU. The effect of ED CLABSI prevention practices requires further research dedicated to surveying ED CLABSI rates.