Preventing Bloodstream Infections Linked to Central Lines (Catheters)

When a patient is in the hospital, he or she often needs to be given medicines or fluids or have blood. Sometimes this is done through a central line or catheter. A central line is a tube that is put into a large vein, usually in the neck, chest, arm or groin. The line may be left in place for several weeks. The risk of infection increases with the increased duration of time a central line is in place.

If bacteria or other germs get into a central line, they can enter the bloodstream and cause an infection. Signs of such an infection may include fevers and chills. Sometimes, the area around where the tube has been inserted into the vein becomes red or sore.

These types of infections are serious. They often can be treated successfully with antibiotics and removal of the central line.

At Cedars-Sinai, many precautions are taken to prevent central line associated bloodstream infections, including:

  • Choosing the best location for putting in a central line
  • Properly cleaning the hands before putting in the central line
  • Wearing a mask, cap, sterile gown and sterile gloves when putting in a central line
  • Covering the patient with a sterile sheet
  • Properly cleaning the patient's skin before putting the line in
  • Properly cleaning the hands, wearing sterile gloves and cleaning the catheter opening before using the central line to give medicines or draw blood
  • Carefully handling medicines and fluids that are given through the central line
  • Properly cleaning the hands and wearing sterile gloves when changing the bandage that covers the area where the catheter enters the skin
  • Removing the central line as soon as it is no longer needed

As part of its commitment to improving the quality of care given to patients at Cedars-Sinai, the rate of central line infections is monitored carefully.

California hospitals are required to report these infections to the California Department of Public Health and the National Healthcare Safety Network, part of the Centers for Disease Control and Prevention (CDC). The California department is required to adjust the data for risk factors according to the federal network's protocols. The risk adjustment methodology uses national data to compare the actual number of infections to the expected number, based on the age and health of the surgery patients.

The chart below shows the rate of central line-linked bloodstream infections that occurred in patients in the Adult Intensive Care Units at Cedars-Sinai vs. the expected number.

What Is the Standardized Infection Ratio?

The standardized infection ratio is a summary measure used to track infections at a national, state or local level over time. The ratio compares the actual number of infections reported to what would be predicted, adjusting for risk factors that have been found to be significantly associated with differences in infection incidence. A lower number is better.

Impact on Standardized Infection Ratios After 2015 Rebaselining

The National Healthcare Safety Network instituted the new 2015 baseline time period for the number predicted calculation. The data included in the 2015 baseline will serve as a new reference point for comparing progress. CDC expects that hospital standardized infection ratios will increase and shift closer to 1. This shift reflects nationwide improvement in infection prevention from the previous baseline time period.