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Gram negatives elude CLABSI prevention
CDC creating catheter maintenance bundle
In compiling national surveillance data on central line associated blood stream infections (CLABSIs) the Centers for Disease Control and Prevention made an interesting finding: Reductions in CLABSIs caused by Staphylococcus aureus were more marked than reductions in infections caused by gram-negative rods, such as Candida and Enterococcus.1
With multidrug resistant gram negative infections becoming an increasing threat, the finding gives one pause but may have a straightforward explanation.
"We suspect the current focus on the proper insertion of catheters would be more likely to influence those types of pathogens that are more likely to be on the skin and therefore could be a cause of an infection related to putting the catheter in," says Arjun Srinivasan, MD, associate director for Healthcare Associated Infection Prevention Programs at the CDC. "Of the organisms that cause these infections, Staph aureus is the one that is most likely to be on a person's skin."
Of course S. aureus, particularly the methicillin-resistant variety, has been the subject of eradication campaigns that include active screening and "seek and destroy" programs. "The other reason we think this could be happening is that there is a lot of attention in health care on reducing or preventing MRSA," he adds.
The smaller reduction among gram negative pathogens suggests a need for improved implementation of post-insertion line-maintenance practices and strategies to ensure prompt removal of unneeded central lines.
"Gram negative [infections] are more likely to occur as the result of the way the catheter is maintained, rather than the way it is put in," Srinivasan says. "So to prevent infections with these other pathogens we need to be focusing on people who already have a catheter in and look at the proper maintenance of the catheter. There may be other factors that we don't really understand yet, but this difference was important for us to point out."
The CDC is consulting with experts with an eye toward developing protocols and checklists essentially a central line maintenance bundle similar to the approach that has had so much success for insertion.
"When catheters are placed we know exactly what we want people to do every time," he says. "We want to have similar steps that they can use and follow every time a catheter is used or cared for."
Focusing on antibiotic-resistant pathogens is especially important given the increased risk for mortality associated with these pathogens. The variation in reductions among different organisms underscores the importance of collecting pathogen and susceptibility information as part of CLABSI surveillance, the CDC concluded.