1480. Impact of Avoiding Central Vascular Catheter-Drawn Blood Samples for Culture in a Large Tertiary Care University Hospital
Session: Poster Abstract Session: HAI: Surveillance and Public Reporting
Friday, October 28, 2016
Room: Poster Hall
Background: Uncertainty regarding the significance of central line blood culture results prompted the CDC to recommend avoiding their use unless absolutely necessary. The effectiveness and safety of enforcing this policy in a hospital that cares for immunocompromised hosts is unknown.

Methods: We examined the impact of avoiding the use of catheter-drawn blood samples for culture unless absolutely necessary at a tertiary care hospital that also cares for patients with cancer, stem cell transplants and solid-organ transplants. Hospital-wide enforcement began in September 2013. The pre-implementation era was defined from August 2012 to July 2013, and the post-implementation era was defined from January 2014 to December 2015. The following outcomes were compared between eras: 1) number of blood cultures per 1,000 inpatient days; 2) number of blood cultures from central lines per 1,000 inpatient days; 3) number of positive blood cultures per 1,000 inpatient days; 4) number of central-line associated bloodstream infections (CLABSIs) meeting National Healthcare Safety Network (NHSN) definitions per 1,000 central line days; 5) length of stay; 6) inpatient death.

Results:  The number of blood cultures decreased two-fold from 144 to 72 per 1,000 inpatient days, and the number of blood cultures drawn from central lines decreased eight-fold from 24 to 3 per 1,000 inpatient days between pre- and post-implementation eras. The number of positive blood cultures decreased by a third from 14 to 9 per 1,000 inpatient days, whereas the number of CLABSIs meeting NHSN definitions decreased three-fold from 3 to 1 per 1,000 central line days between eras. The mean length of stay was unchanged at 3.8 and 4.0 days (p=0.316), and the number of inpatient deaths per 1,000 admissions was stable at 8.5 and 9.2 (p=0.240) between eras. The mean length of stay for patients admitted to cancer and transplant units was unchanged at 6.4 and 6.5 days (p=0.609), and the number of inpatient deaths per 1,000 admissions at cancer, transplant and intensive care units was stable at 41.2 and 47.1 (p=0.131) between eras.

Conclusion:  Avoiding the use of catheter-drawn blood samples for culture can effectively decrease CLABSIs meeting NHSN criteria without adversely impacting patient outcomes.

 

Carlos Santos, MD MPHS1, Teppei Shimasaki, M.D.1, Ekta Kishen, MPH1, Sarah Won, M.D.2, Amy Hanson, PharmD3, Gigi Marinakos, MPH1, Alexander Tomich, RN DNP1, Bala Hota, MD1 and John Segreti, MD, FIDSA, FSHEA4, (1)Rush University Medical Center, Chicago, IL, (2)RUSH University Medical Center, Chicago, IL, (3)Department of Pharmacy, Rush University Medical Center, Chicago, IL, (4)Infectious Disease, Rush University Medical Center, Chicago, IL

Disclosures:

C. Santos, None

T. Shimasaki, None

E. Kishen, None

S. Won, None

A. Hanson, None

G. Marinakos, None

A. Tomich, None

B. Hota, None

J. Segreti, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.