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Epidemiol Infect. 2017 Oct;145(14):3047-3055. doi: 10.1017/S095026881700187X. Epub 2017 Sep 4.

Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities.

Author information

1
Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre,Melbourne, Victoria,Australia.
2
The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation,Melbourne, Victoria,Australia.
3
Department of Epidemiology and Preventive Medicine,Faculty of Medicine, Nursing and Health Sciences,Monash University,Melbourne, Victoria,Australia.

Abstract

Central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as 'modifiable' and 'non-modifiable', enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010-2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01-1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37-0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29-0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.

KEYWORDS:

Central line-associated bloodstream infection (CLABSI); preventable; risk; ultrasound-guidance

PMID:
28868995
DOI:
10.1017/S095026881700187X
[Indexed for MEDLINE]

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