UC San Diego

Objective: Central line-associated bloodstream infections (CLABSIs) are associated with high morbidity and mortality, longer hospital stays, and increased healthcare costs. It was hypothesized that the adoption of a new anchoring device (SecurAcath) for peripherally inserted central catheters (PICCs) in May 2021 had contributed to a reduction in CLABSI incidence at University of California San Diego (UCSD) hospitals in La Jolla and Hillcrest. This study aimed to investigate if the overall decline in CLABSI incidence was associated with a decline in PICC CLABSI using SecurAcath. Methods: We conducted a retrospective cohort study involving 106 patients with CLABSI who had one or more central lines (CL) in place more than two calendar days before the onset of CLABSI from January 1st, 2020, to July 31st, 2022, at UCSD hospitals. Data was divided into intervention (exposed to SecurAcath) and pre-intervention (unexposed to SecurAcath) groups. The variables of interest were CLABSI event date, CL types, and CL insertion and removal dates and location. Standardized infection rate (SIR) and CLABSI incidence rate (per 1000 line-days) were calculated to compare the two groups. Results: The SIR was not significantly changed (Pre = 0.54 vs. Intervention = 0.46, P-value = 0.3827), and CLABSI rates (per 1000 line-days) by CL type did not find significant differences between the two groups. When all patients were examined irrespective of time, the CLABSI rate for single internal jugulars (IJs) was higher than other single CLs (1.7/1000 line-days, P-value = 0.0002). In contrast, the CLABSI rate for multiple CLs: PICC and port-a-cath (PORT) was lower than other multiple CLs (0.09/1000 line-days, P-value = 0.0264). Conclusion: This study did not find evidence of a decrease in CLABSI following the universal adoption of SecurAcath devices for PICCs at UCSD hospitals. However, we found that single high-risk CLs were associated with a higher CLABSI rate, while combined use of low-risk CLs was associated with lower CLABSI rate. Surveillance of bloodstream infections inclusive of all CL types is needed to identify impactful interventions and assess other benefits associated with SecurAcath.