Catheter-associated bloodstream infection rates: how low can you go?

Excerpt

Device-associated infections remain an important challenge in intensive care units (ICU) as they come with considerable morbidity and possibly mortality [1, 2]. The average preventable proportion of healthcare-associated infection has been estimated to be 30%, but ranges from 10% to 70% [3]. This large variety can be explained by the fact that the risk reduction depends on setting, study design, baseline infection rate, and type of infection. Regarding the last of these, catheter-related bloodstream infection (CRBSI) is probably the infection that is most easy to avoid. Catheter-associated BSI (CABSI) is a surrogate that includes CRBSI and primary BSI. CABSI occurrence is mainly attributed to failure of infection control practices and less on underlying clinical conditions facilitating infection. The value of quality improvement interventions targeting optimized processes of care has been successfully demonstrated [4, 5]. Through high adherence to standard prevention recommendations, central line-associated bloodstream infection rates around or even below 1 per 1000 catheter-days can be achieved. Aiming for zero seems no longer unfeasible. The question arises whether CABSI can be avoided for extended periods of time by exclusively investing in optimizing processes of care. After all, despite all efforts, human error cannot be ruled out. Technological and biomaterial innovation can pave the way for preventing the very last cases of CABSI. However, with baseline infection rates close to zero it becomes increasingly difficult to demonstrate clinical benefit in a significant way. One might argue that the clinical relevance of avoiding the very last CABSI cases might overrule a non-statistically significant risk reduction [6]. At the same line, with decreasing baseline infection rates, the challenge for an innovative approach to demonstrate cost-effectiveness becomes harder. However, with an average cost of around 18,000 euros for a single episode of CABSI, cost-effectiveness in prevention is relatively easily achieved [7]. …