Program Schedule

Blood Product Transfusions and the Risk of Central Line-Associated Bloodstream Infections (CLABSI)

Session: Oral Abstract Session: CLABSI: Surveillance and Prevention
Saturday, October 11, 2014: 9:00 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: Blood product transfusions have increasingly been recognized as a risk factor for the development of infection but the relationship between transfusions and the development of CLABSIs is unclear. This study investigated the relationship between transfusions of packed Red Blood Cells (PRBCs), platelets and fresh frozen plasma (FFP) and CLABSI.

Methods:    This retrospective case-control study took place from December 2009-June 2011 at two academic medical centers.  Adult patients with CLABSIs were matched 1:4 by admission month and year with control patients who had a central venous catheter but who did not develop a CLABSI. Patients with a CLABSI attributed to dialysis catheters were excluded. The type of blood product and number of units transfused were obtained for all cases and controls.  Additional variables for analysis included hospital, line type and location, dwell time, intensive care unit (ICU) admission, total parenteral nutrition (TPN), hemodialysis, and length of stay.

Results: There were 110 CLABSIs with a mean line dwell time of 10.5 days prior to development of infection; controls had a mean dwell time of 6 days.  In univariate analysis transfusion of PRBCs, but not FFP or platelets, was associated with CLABSI (OR=2.02; p=0.001).   There was a statistically significant dose related response of CLABSI risk as the number of units transfused increased from 1-2 PRBCs (OR=1.60) to 3-6 PRBCs (OR=2.31) to >6 PRBCs (OR=2.47).  Cases had a longer length of stay (28.9 vs. 10.6 days, p<0.0001), more frequently had an ICU admission (55% vs. 43%, p=0.017),  and more frequently received TPN (39% vs. 8%, p=<0.0001) compared to controls.  PRBC transfusion remained a risk factor for CLABSI (OR=1.96, p=0.004) in the multivariate model including TPN and short-term central lines.

Conclusion: Transfusion of PRBCs is a risk factor for the development of CLABSIs. Efforts to adhere to new guidelines with conservative transfusion thresholds (hemoglobin < 7 mg/dL) should be included in interventions to prevent CLABSI.

Kristin Hake, RN, MPH1, James Steinberg, MD2 and Jesse Jacob, MD2, (1)Infection Control and Prevention, Emory Healthcare, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA


K. Hake, None

J. Steinberg, None

J. Jacob, None

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