Current Infectious Disease Reports

, Volume 13, Issue 4, pp 343–349 | Cite as

Prevention of Central Line–Associated Bloodstream Infections: A Journey Toward Eliminating Preventable Harm

  • Kristina R. Weeks
  • Christine A. Goeschel
  • Sara E. Cosgrove
  • Mark Romig
  • Sean M. Berenholtz


Central line–associated blood stream infections (CLABSI) are among the most common, lethal, and costly health care–associated infections. Recent large collaborative quality improvement efforts have achieved unprecedented and sustained reductions in CLABSI rates and demonstrate that these infections are largely preventable, even for exceedingly ill patients. The broad acceptance that zero CLABSI rates are an achievable goal has motivated and stimulated diverse groups of stakeholders, including public and private groups to develop policy tools and to mobilize their local constituents toward achieving this goal. Nevertheless, attributing reductions in CLABSI rates achieved by multifaceted quality improvement efforts solely to the use of checklists to ensure adherence with appropriate infection control practices is an easily made but crucial mistake. National CLABSI prevention is a shared responsibility and creating novel partnerships between government agencies, health care industry, and consumers is critical to making and sustaining progress in achieving the goals toward eliminating CLABSI.


Central line infections Health care–acquired infections Health care–associated infections Health policy CLABSI 


Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance

  1. 1.
    •• Klevens RM, Edwards JR, Richards CL, Jr., et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007 03;122(0033–3549; 2):160–166. This study depicts the burden of HAIs and deaths in United States by providing national estimates of mortality associated with HAIs. Google Scholar
  2. 2.
    • Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009. Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, February 2009. 2009; Available at: Accessed January 2011. This report provides estimates for the annual direct hospital cost of treating HAIs in the US.
  3. 3.
    Pien BC, Sundaram P, Raoof N, et al. The clinical and prognostic importance of positive blood cultures in adults. Am J Med. 2010;123(9):819–28.PubMedCrossRefGoogle Scholar
  4. 4.
    Darouiche RO, Raad II, Heard SO, et al. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med. 1999;340(1):1–8.PubMedCrossRefGoogle Scholar
  5. 5.
    O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(10):1–29.PubMedGoogle Scholar
  6. 6.
    Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29(11):996–1011.PubMedCrossRefGoogle Scholar
  7. 7.
    Marschall J, Leone C, Jones M, et al. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol. 2007;28(8):905–9.PubMedCrossRefGoogle Scholar
  8. 8.
    The Joint Commision. 2009 National Patient Safety Goals. Available at: Accessed January, 2011.
  9. 9.
    •• U.S. Department of Health and Human Services: HHS Action Plan to Prevent Healthcare-Associated Infections. Avail at: Accessed January, 2011. This report identifies the key actions needed to achieve and sustain progress in protecting patients from the transmission of serious, and in some cases, deadly infections.
  10. 10.
    Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.PubMedCrossRefGoogle Scholar
  11. 11.
    •• Pronovost PJ, Goeschel CA, Colantuoni E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309. This study describes sustained reductions in CLABSI rates over time in the state of Michigan by implementing the Johns Hopkins model for translating evidence into practice. PubMedCrossRefGoogle Scholar
  12. 12.
    •• Cardo D, Dennehy PH, Halverson P, et al. Moving toward elimination of healthcare-associated infections: A call to action. Am J Infect Control. 2010;38(9):671–675. This report details a call to action to move toward the elimination of HAIs by a partnership of both public and private entities. PubMedCrossRefGoogle Scholar
  13. 13.
    • Centers for Disease Control and Prevention: First State-Specific Healthcare-Associated Infections Summary Data Report: January-June, 2009. Released May 27, 2010. Accessed January, 2010. This seminal CDC report presents national and state-level CLABSI rates based on data available from NHSN. Google Scholar
  14. 14.
    •• Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 (1):22–30. This paper highlights practical recommendations for implementing and prioritizing CLABSI prevention efforts. CrossRefGoogle Scholar
  15. 15.
    Bosma JW, Siegert CE, Peerbooms PG, Weijmer MC. Reduction of biofilm formation with trisodium citrate in haemodialysis catheters: a randomized controlled trial. Nephrol Dial Transplant. 2010;25(4):1213–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Schindler R, Heemann U, Haug U, et al. Bismuth coating of non-tunneled haemodialysis catheters reduces bacterial colonization: a randomized controlled trial. Nephrol Dial Transplant. 2010;25(8):2651–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Walz JM, Avelar RL, Longtine KJ, et al. Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization. Crit Care Med. 2010;38(11):2095–102.PubMedCrossRefGoogle Scholar
  18. 18.
    Abbas SA, Haloob IA, Taylor SL, et al. Effect of antimicrobial locks for tunneled hemodialysis catheters on bloodstream infection and bacterial resistance: a quality improvement report. Am J Kidney Dis. 2009;53(3):492–502.PubMedCrossRefGoogle Scholar
  19. 19.
    Chow KM, Poon YL, Lam MP, et al. Antibiotic lock solutions for the prevention of catheter-related bacteraemia in haemodialysis patients. Hong Kong Med J. 2010;16(4):269–74.PubMedGoogle Scholar
  20. 20.
    Slobbe L, Doorduijn JK, Lugtenburg PJ, et al. Prevention of catheter-related bacteremia with a daily ethanol lock in patients with tunnelled catheters: a randomized, placebo-controlled trial. PLoS ONE. 2010;5(5):e10840.PubMedCrossRefGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention (CDC). Reduction in central line-associated bloodstream infections among patients in intensive care units–Pennsylvania, April 2001-March 2005. MMWR Morb Mortal Wkly Rep. 2005;54(40):1013–6.Google Scholar
  22. 22.
    U.S. Department of Health and Human Services: Secretary Sebelius Releases Inaugural Health Care “Success Story” Report 2011Google Scholar
  23. 23.
    Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ;337.Google Scholar
  24. 24.
    Timmel J, Kent PS, Holzmueller CG, et al. Impact of the Comprehensive Unit-based Safety Program (CUSP) on safety culture in a surgical inpatient unit. Jt Comm J Qua Patient Saf. 2010;36(6):252–60.Google Scholar
  25. 25.
    • Lipitz-Snyderman A, Steinwachs D, Needham DM, et al. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis. BMJ 2011;342:d219. This paper demonstrated that implementation of the Keystone ICU project focused on CLABSI reduction was associated with a significant decrease in hospital mortality in Michigan compared with the surrounding area. Google Scholar
  26. 26.
    Duane TM, Brown H, Borchers CT, et al. A central venous line protocol decreases bloodstream infections and length of stay in a trauma intensive care unit population. Am Surg. 2009;75(12):1166–70.PubMedGoogle Scholar
  27. 27.
    Miller RS, Norris PR, Jenkins JM, et al. Systems initiatives reduce healthcare-associated infections: a study of 22,928 device days in a single trauma unit. J Trauma. 2010;68(1):23–31.PubMedCrossRefGoogle Scholar
  28. 28.
    Peredo R, Sabatier C, Villagra A, et al. Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention. Eur J Clin Microbiol Infect Dis. 2010;29(9):1173–7.PubMedCrossRefGoogle Scholar
  29. 29.
    •• DePalo VA, McNicoll L, Cornell M, et al. The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide. Qual Saf Health Care 2010;19:555–61. This paper describes Rhode Island's replication of the Johns Hopkins model initially carried out in the Michigan Keystone ICU project and reports substantial reductions in CLABSI rates. PubMedCrossRefGoogle Scholar
  30. 30.
    • Bosk CL, Dixon-Woods M, Goeschel CA, et al. Reality check for checklists. Lancet 2009;374(9688):444–445. This article lauds the use of checklists to standardize practice but emphasizes the need to use them within a more comprehensive strategy that integrates efforts to improve teamwork and social climate within clinical areas. PubMedCrossRefGoogle Scholar
  31. 31.
    Heifetz RA. Leadership without easy answers. Cambridge, Mass.: Belknap Press of Harvard University Press, 1994.Google Scholar
  32. 32.
    Sawyer M, Weeks K, Goeschel CA, et al. Using evidence, rigorous measurement, and collaboration to eliminate central catheter-associated bloodstream infections. Crit Care Med. 2010;38(8):S292–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Pronovost PJ, Berenholtz SM, Goeschel C, et al. Improving patient safety in intensive care units in Michigan. J Crit Care. 2008;23(2):207–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Colla JB, Bracken AC, Kinney LM, Weeks WB. Measuring patient safety climate: a review of surveys. Qual Saf Health Care. 2005;14(5):364–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Office of Inspector General. Adverse events in hospitals:national incidence among medicare beneficiaries. Department of Health and Human Services, 2010. Avail at Accessed January 2011.
  36. 36.
    2009 National Healthcare Disparities and Quality Reports. Available at Accessed January 2011.
  37. 37.
    Eliminating CLABSI. A National Patient Safety Imperative: A Progress Report on the National On the CUSP: Stop BSI Project. Agency for Healthcare Research and Quality 2010. AHRQ Publication No: 11-0037-EF Release date April 2011. Available at Accessed April 04 2011.
  38. 38.
    Goeschel CA, Holzmueller CG, Pronovost PJ. Hospital Board Checklist to improve culture and reduce central line-associated bloodstream infections. Jt Comm J Qual Patient Saf. 2010;36(11):525–8.PubMedGoogle Scholar
  39. 39.
    Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 2005;33(9):501–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Roberts RR, Scott 2nd RD, Cordell R, et al. The use of economic modeling to determine the hospital costs associated with nosocomial infections. Clin Infect Dis. 2003;36(11):1424–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Sexton JB, Lyon JS, Berenholtz SM, Holzmueller C, Thomas EJ, Thompson DA, Goeschel CA, Watson SR, Knight AP, Pronovost PJ. Assessing and Improving Safety Climate in a Statewide Sample of ICUs. Crit Care Med 2011 Feb 3. [Epub ahead of print].Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kristina R. Weeks
    • 1
  • Christine A. Goeschel
    • 1
    • 2
    • 3
  • Sara E. Cosgrove
    • 4
  • Mark Romig
    • 5
  • Sean M. Berenholtz
    • 1
    • 3
  1. 1.Departments of Anesthesiology and Critical Care Medicine, Quality and Safety Research GroupJohn Hopkins University School of MedicineBaltimoreUSA
  2. 2.John Hopkins University School of NursingBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Medicine, Division of Infectious DiseasesJohn Hopkins Medical InstitutionsBaltimoreUSA
  5. 5.Departments of Anesthesiology and Critical Care MedicineJohn Hopkins UniversityBaltimoreUSA

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