Surveillance for central line-associated bloodstream infection

A central line-associated bloodstream infections (CLABSI) is a serious infection that usually requires significant treatment and a prolonged length of stay in hospital. A CLABSI can be prevented through correct insertion and line maintenance techniques, the Surveillance Implementation Guide supports these processes.

Surveillance Implementation Guide

A CLABSI can be prevented through correct insertion and line maintenance techniques. Most states and territories have established either voluntary or mandatory reporting requirements for CLABSI.

The Commission has also developed a surveillance implementation guide for CLABSI to support Australian hospitals undertaking surveillance and reporting of CLABSI.

Case Definition

A central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection in a patient where the central line was in place for >48 hours on the date of the event.*

AND

The central line was in place on the date of the event or the day before. If the central line was in place for >48 hours and then removed, the CLABSI criteria must be fully met on the day of discontinuation or the next day.

CLABSI must meet one of the following criteria:

Criterion 1

A patient of any age has a recognised bacterial or fungal pathogen cultured from one or more blood cultures

AND

the organism cultured from blood is not related to an infection at another site.

Criterion 2

A patient of any age has at least one of the following signs or symptoms: fever (> 38°C), chills or hypotension.

OR

A patient < 1 year of age has at least one of the following signs or symptoms: fever (> 38°C core), hypothermia (< 36°C core), apnoea or bradycardia

AND

the organism cultured from blood is not related to an infection at another site

AND

the same (matching) potential contaminant organism is cultured from two or more sets of blood cultures drawn on separate occasions within 24 hours.

Criterion elements, such as positive blood cultures and fever, must occur within a seven day timeframe (the three days before and the three days after) the day on which the positive blood culture was drawn.

The same (matching) potential contaminant organisms represent a single element of any of the criteria. The collection date of the first positive blood culture should be used to determine the date of the event.

Notes:

*The Centers for Disease Control (CDC)/National Hospital Safety Network (NHSN) and some Australian states and territories use calendar days (>2 calendar days) as the metric for the duration of central line placement, with device placement being Day 1. A consistent metric must be used, whether it is hours or days.

† Potential contaminant organisms (referred to as common commensals by the NHSN) include: diphtheroids [Corynebacterium spp. not C. diphtheria], Bacillus spp. [not B. anthracis], Propionibacterium spp., coagulase negative staphylococci [including S. epidermidis], viridans group streptococci, Aerococcus spp., Micrococcus spp., and Rhodococcus spp.