Mucosal Barrier Injury Central-Line–Associated Bloodstream Infections: What is the Impact of Standard Prevention Bundles?

• Published in: Infection control and hospital epidemiology Vol. 38; no. 11; pp. 1385 - 1387
• Main Authors: Vaughan, Ana M., Ross, Rachael, Gilman, Margaret M., Satchell, Lauren, Ditaranto, Susan, Reilly, Anne F., Kersun, Leslie S., Shanahan, Amanda, Coffin, Susan E., Sammons, Julia Shaklee
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.11.2017
• Subjects: Adolescent; Bacteremia - etiology; Bacteremia - microbiology; Bacteremia - prevention & control; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Catheters; Child; Child, Preschool; Cross Infection - etiology; Cross Infection - microbiology; Cross Infection - prevention & control; Disease control; Enterobacter cloacae; Equipment Contamination; Escherichia coli; Hospitals; Hospitals, Pediatric; Humans; Infection Control - methods; Infections; Klebsiella Infections; Klebsiella pneumoniae; Laboratories; Leukemia; Medical instruments; Microorganisms; Neutropenia; Oncology; Patient safety; Philadelphia - epidemiology; Prevention; Retrospective Studies; Streptococcal Infections; Streptococcus mitis; Surveillance; Translocation; Trends; Philadelphia
• DOI: 10.1017/ice.2017.188
• ISSN: 0899-823X; 1559-6834

Recognizing the unique challenges posed by neutropenia and impaired gut integrity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network introduced a revised surveillance protocol for CLABSIs in January 2013 that included a new classification for mucosal-barrier injury (MBI) laboratory-confirmed bloodstream infection.1–4 Many hypothesize that MBI CLABSIs are related to translocation of enteric microorganisms across a disrupted intestinal epithelium, suggesting that bundles focused on catheter insertion and maintenance would not impact infection rates.3,5 Through a retrospective, stratified analysis of in-house data, we describe changes in MBI and non-MBI CLABSIs in oncology patients at our institution. DISCUSSION Following efforts to improve central-line care bundles, prior reports separating CLABSI data by MBI vs non-MBI identified disparate trends in rates.3,5 Researchers concluded that standard CLABSI bundles were insufficient to impact MBI rates.5 However, we observed a similar rate of change in our MBI and non-MBI CLABSIs in a period of ongoing efforts to prevent CLABSIs in this population. The use of surveillance definitions subject to change is a potential limitation in our study. Since its inception, the MBI definition underwent a single modification in 2014, wherein the neutropenia screening window was increased from 4 days (day of positive culture plus the 3 preceding days) to 7 (day of positive culture plus the 3 preceding days and the 3 days following the culture).