Skip to main content Accessibility help

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis

  • Yoona Rhee (a1) (a2), Michael Heung (a1) (a2) (a3), Benrong Chen (a1) (a4) and Carol E. Chenoweth (a1) (a2) (a5)



Little is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort.


Retrospective observational study from January 2010 to December 2011


An 880-bed tertiary teaching hospital


Patients with CLABSI in non–ICU wards


CLABSI patients were identified from existing infection-control databases and primary chart review was conducted. National Health and Safety Network (NHSN) definitions were utilized for CLABSI and pathogen classification. CLABSI rates were calculated per patient day. Total mortality rates were inclusive of hospice patients.


Over a 2-year period, 104 patients incurred 113 CLABSIs for an infection rate of 0.35 per 1,000 patient days. The mean length of hospital stay prior to CLABSI was 16±13.3 days, which was nearly 3 times that of hospital-wide non-ICU length of stay. Only 11 patients (10.6%) received dialysis within 48 hours of CLABSI. However, 67% of patients had a hematologic malignancy, and 91.8% of those admitted with a malignant hematologic diagnosis were neutropenic at the time of CLABSI. Enterococcus spp. was the most common organism recovered, and half of all central venous catheters (CVCs) present were peripherally inserted central catheters (PICC lines). Mortality rates were 18.3% overall and 27.3% among dialysis patients.


In patients with CLABSIs outside of the ICU, only 10.6% received dialysis prior to infection. However, underlying hematologic malignancy, neutropenia, and PICC lines were highly prevalent in this population.

Infect Control Hosp Epidemiol 2015;00(0):1–7


Corresponding author

Address correspondence to Yoona Rhee, MD, Rush University Medical Center, Section of Infectious Diseases, 600 South Paulina St., Suite 143, Chicago, IL 60612 (


Hide All
1. 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 2002;51:129.
2. Centers for Disease Ccontrol and Prevention. Vital signs: central line-associated bloodstream infections—United States, 2001, 2008, and 2009. MMWR 2011;60:243248.
3. Tedja, R, Gordon, SM, Fatica, C, Fraser, TG. The descriptive epidemiology of central line-associated bloodstream infection among patients in non-intensive care unit settings. Infect Control Hosp Epidemiol 2014;35:164168.
4. Kallen, AJ, Patel, PR, O’Grady, NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010;51:335341.
5. Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942945.
6. Marschall, J, Leone, C, Jones, M, Nihill, D, Fraser, VJ, Warren, DK. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol 2007;28:905909.
7. Zingg, W, Sax, H, Inan, C, et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009;73:4146.
8. Shapey, IM, Foster, MA, Whitehouse, T, Jumaa, P, Bion, JF. Central venous catheter-related bloodstream infections: improving post-insertion catheter care. J Hosp Infect 2009;71:117122.
9. Trick, WE, Vernon, MO, Welbel, SF, Wisniewski, MF, Jernigan, JA, Weinstein, RA. Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol 2004;25:266268.
10. U.S. Renal Data System, USRDS 2012 Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
11. D'Agata, EM, Mount, DB, Thayer, V, Schaffner, W. Hospital-acquired infections among chronic hemodialysis patients. Am J Kidney Dis 2000;35:10831088.
12. Al-Rawajfah, OM, Stetzer, F, Hewitt, JB. Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol 2009;30:10361044.
13. Device Associated Module CLABSI. Centers for Disease Control and Prevention National Healthcare Safety Network website. Published 2011, 2014. Accessed November 20, 2011 and March 14, 2014.
14. List of Medications Contraindicating Receipt of Smallpox Vaccine. Centers for Disease Control and Prevention website., Published 2003. Accessed February 5, 2012.
15. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286300.
16. Son, CH, Daniels, TL, Eagan, JA, et al. Central line-associated bloodstream infection surveillance outside the intensive care unit: a multicenter survey. Infect Control Hosp Epidemiol 2012;33:869874.
17. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol 2007;28:13611366.
18. Kelly, MS, Conway, M, Wirth, KE, Potter-Bynoe, G, Billett, AL, Sandora, TJ. Microbiology and risk factors for central line-associated bloodstream infections among pediatric oncology outpatients: a single institution experience of 41 cases. J Pediatric Hematol Oncol 2013;35:e71e76.
19. Boersma, RS, Jie, KS, Verbon, A, van Pampus, EC, Schouten, HC. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Annal Oncol 2008;19:433442.
20. Mollee, P, Jones, M, Stackelroth, J, et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect 2011;78:2630.
21. Elishoov, H, Or, R, Strauss, N, Engelhard, D. Nosocomial colonization, septicemia, and Hickman/Broviac catheter-related infections in bone marrow transplant recipients. A 5-year prospective study. Medicine 1998;77:83101.
22. Carlisle, PS, Gucalp, R, Wiernik, PH. Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993;14:320324.
23. Dettenkofer, M, Ebner, W, Bertz, H, et al. Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant 2003;31:795801.
24. Tomlinson, D, Mermel, LA, Ethier, MC, Matlow, A, Gillmeister, B, Sung, L. Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis 2011;53:697710.
25. Steinberg, JP, Robichaux, C, Tejedor, SC, Reyes, MD, Jacob, JT. Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013;34:171175.
26. Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52:14461450.
27. Digiorgio, MJ, Fatica, C, Oden, M, et al. Development of a modified surveillance definition of central line-associated bloodstream infections for patients with hematologic malignancies. Infect Control Hosp Epidemiol 2012;33:865868.
28. Dutcher, K, Lederman, ER, Brodine, S, Patel, S. Impact of the 2013 revised Centers for Disease Control and Prevention central line-associated bloodstream infection (CLABSI) surveillance definition on inpatient hospital CLABSI rates: is it enough? Infect Control Hosp Epidemiol 2013;34:9991001.
29. Freeman, JT, Elinder-Camburn, A, McClymont, C, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013;34:8992.
30. Chopra, V, O’Horo, JC, Rogers, MA, Maki, DG, Safdar, N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908918.
31. Cheong, K, Perry, D, Karapetis, C, Koczwara, B. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours. Internal Med J 2004;34:234238.
32. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med 2006;355:27252732.
33. 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.

Related content

Powered by UNSILO

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis

  • Yoona Rhee (a1) (a2), Michael Heung (a1) (a2) (a3), Benrong Chen (a1) (a4) and Carol E. Chenoweth (a1) (a2) (a5)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.