Central line-associated bloodstream infections (CLABSI) remain a significant source of morbidity and mortality, though recent efforts have decreased their rate of occurrence. We have observed several cases of CLABSI in patients suspected of manipulating central lines and self-injecting illicit substances during inpatient stays. We sought to determine the burden of this practice, and its relation to hospital onset CLABSI at our institution. Very little research has been conducted regarding the potential infection rates of individuals who are believed to self-manipulate their central access lines.
A case-control study was performed comparing CLABSI cases at our institution between Jan 1, 2012 and June 1, 2014 to control patients with central lines who did not develop CLABSI. IV drug abuse (IVDA) was assessed as a contributing risk factor for the hospital acquisition of CLABSI. Records were then searched for references of intravenous drug abuse or drug abuse history. In addition, organisms isolated from reported CLABSI were recorded.
18 patients were identified as having a hospital-onset CLABSI during the study period. IVDA was identified as a risk behavior in 50% of the cases, and 7.7% of the controls. People that had a CLABSI were 12 times more likely to be suspected IVDA (95% CI 2.69-53.62). Candida sp. were more frequently isolated in patients with IVDA.
Patients with central line infection were more likely to be intravenous drug users than patients without CLABSI. From this we conclude IV drug abuse to be a risk factor for central line infection. With evidence of atypical organisms isolated from the IVDA group, we theorize that these patients had been self-injecting into their central venous access, however, are limited because this behavior is usually not directly observed. Self injection of lines is a significant patient safety risk, albeit a challenging one to prevent, as no commercial devices exist that prevent line tampering. As a medical center serving patients in an area of epidemic IVDA, publicly reported data such as CLABSI can tell a misleading story about institutional efforts to improve infection control and patient safety.
B. Sammons, None