ETC 50 - Implementation of Bloodstream Infection Surveillance of All Vascular Access Devices and Notification Process in a Large Academic Medical Center

Background: Bacteremia is a serious condition that results in high morbidity and mortality rates and prolongs hospital stay. In an effort to decrease bloodstream infections (BSI), we begin surveillance of all vascular access devices using a comprehensive metric for the identification of peripheral line-associated bloodstream infections (PLABSI) and their notification process. PLABSI surveillance aims to identify missed opportunities with vascular access maintenance bundle (VAMB) elements and gaps in processes and systems.

Methods: All positive blood cultures were reviewed and patients with central-line (CL) were eligible for central line-associated BSI (CLABSI) and patients with peripheral intravenous line (PIV) and no CL were eligible for PLABSI. All metrics of National Healthcare Safety Network (NHSN) BSI criteria were followed to identify PLABSI, with the exclusion of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI). Once identified, PLABSI notification was shared with the relevant stakeholders. PLABSI rate was calculated using PIV days, which were collected using the same criteria as NHSN CL days.

Results: In fiscal year (FY) 2020, there were 64 PLABSIs with 229,363 PIV days, with an infection rate of 0.28 per 1000 PIV days. In FY2021, PLABSIs decreased to 46 with PIV days of 260,247 and a rate of 0.18 per 1000 PIV days. However, an increase occurred in FY2022 with 71 PLABSIs and 266,139 PIV days, the rate increased to 0.27 per 1000 PIV days. Finally, in FY2023 a reduction was seen with 59 PLABSIs and rate of 0.22 per 1000 PIV days, despite an increase in PIV days to 272,065.

Conclusions: Implementing a vascular access device surveillance program is integral in identifying missed opportunities with vascular access maintenance bundle elements and processes. The data demonstrates that it is necessary to have compliance of the VAMB and education of staff is essential.