Background: Device stewardship is an important infection prevention opportunity for catheter-associated urinary tract infection reduction. This starts with the avoidance of initial catheter placement without definitive clinical need, especially with the option of alternative of non-invasive foley devices for both male and female anatomy. Urinary catheter placement in the Emergency Department (ED) is an area of opportunity where catheter placement could be avoided in favor of non-invasive management. This study assessed potential unnecessary catheter placement in a community hospital-based ED with a focus on ED-placed urinary catheters removed within 24 hours of admission. Methods: All patient encounters with an indwelling urinary catheter placed in 3 community hospital EDs from May 20, 2024 through September 29, 2025 were included. Encounters for patients who required chronic urinary catheterization (defined as the presence of a urinary catheter for ≥ 45 days) who had catheter replacement in the ED were excluded. The frequency of possible unnecessary catheter placement was defined as the number of catheters removed within 24 hours out of the total encounters. A subset of charts for encounters with a possible unnecessary catheter placed were reviewed to assess for commonalities to guide quality improvement. Results: During the study period, across all 3 facilities, 27.7% (385/1391) of urinary catheters placed in the ED were removed within 24 hours with a similar frequency at each individual facility (Hospital 1 = 24.6% (82/334), Hospital 2 = 24.9% (121/486), Hospital 3 = 31.9% (182/571)). The monthly frequency of possible unnecessary catheter placement ranged between 12.5% to 48.4% (Figure 1). Based on chart review, several common themes were noted, including placement in patients with altered mental status without hemodynamic instability and in patients with brief transient hemodynamic instability weaned from low dose inotropic medications and ventilation within 24 hours of admission. A clinical decision-making tool was created targeting recurrent scenarios that might warrant catheter avoidance (Figure 2). Discussion: ED placement of urinary catheters that were quickly removed by clinical teams upon admission was common across 3 community-based hospitals, highlighting possible unnecessary placement upon evaluation by the inpatient teams. A proposed clinical decision tool was created to help guide physicians in the reasoning behind the perceived need for catheter placement in the ED versus waiting to evaluate clinical need upon admission based upon patient course and failure of alternative methods for urine output management.

Background: Inappropriate urine culture ordering in hospitalized patients with indwelling urinary catheters contributes to unnecessary antibiotic exposure and increased risk of catheter-associated urinary tract infections (CAUTI). Urine Culture Stewardship Interventions have emerged as strategies to reduce unnecessary urine culture testing and downstream antibiotic use; however, the magnitude of their impact across clinical settings remains incompletely characterized. Methods: We conducted a scoping review following PRISMA-ScR guidelines to identify studies evaluating urine culture stewardship interventions in hospitalized adults (≥18 years) with indwelling urinary catheters. A systematic literature search was performed in PubMed, Cochrane Library, Web of Science, and Scopus from inception through June 2025, using predefined terms related to indwelling urinary catheters, urinary tract infections and CAUTI, urine culture and diagnostic stewardship, antibiotic use, and catheter management strategies. Interventions included reflex urine culture protocols, catheter replacement prior to specimen collection, educational initiatives, and multicomponent stewardship bundles. Outcomes of interest were urine culture utilization, CAUTI rates, and antibiotic utilization. Data were extracted independently by two reviewers using Covidence. Results were synthesized descriptively, and ranges of relative change were calculated by the review authors when pre- and post-intervention rates were explicitly reported. Results: Conclusion: Urine culture stewardship interventions in hospitalized adults with urinary catheters are consistently associated with meaningful reductions in urine culture utilization and CAUTI rates, with variable but generally favorable effects on antibiotic use. Education-based and reflex urine culture strategies, particularly when embedded within multicomponent stewardship bundles, appear most frequently studied and effective. These findings highlight the potential of diagnostic stewardship as a key component of infection prevention and antimicrobial stewardship efforts, while underscoring the need for standardized outcome reporting and to better quantify downstream clinical impact.

Background: Urine testing is common among hospitalized patients with indwelling urinary catheters, yet variation in collection practices may compromise diagnostic accuracy and contribute to unnecessary downstream interventions. Guidelines recommend avoiding sampling from indwelling catheters when feasible to reduce contamination and detection of asymptomatic colonization. However, real-world compliance and its relationship to diagnostic urine test results, subsequent UTI diagnosis, and antimicrobial prescribing remain incompletely characterized. Methods: We conducted a retrospective medical record review of adult patients who underwent urine testing between March and November 2024 and had an indwelling urinary catheter or catheter removal within the prior 24 hours. Urine samples were classified as compliant if obtained after catheter removal and noncompliant if collected with a catheter in place. Analyses included all urine samples, with urinalysis-specific analyses limited to samples with available results. Urine collection practices, urinalysis parameters, urine culture outcomes, provider-documented UTI diagnoses, concordance with symptom-based criteria and IDSA/NHSN definitions, and antimicrobial prescribing following urine testing (receipt, timing, route, and duration) were summarized descriptively and stratified by compliance status. Results: A total of 921 urine samples were included; 663 had an initial urinalysis with reflex urine culture, while the remainder underwent urine culture alone. Samples compliant with recommended collection practices accounted for 59% of cases. Among samples with urinalysis, overall positivity was similar in compliant and noncompliant samples (57% vs 55%), with comparable urinalysis component positivity across compliance groups. Urine culture positivity was also similar across compliance groups in both reflex-culture and culture-only samples (29% vs 27% and 27% vs 29%). Gram-negative organisms predominated (13-15%), followed by fungi (7-12%) and Gram-positive organisms (2-4%), with fungal isolates more common among noncompliant samples. Antimicrobial therapy was prescribed in 19% of compliant samples compared with 15% of noncompliant samples and was frequently initiated before culture results in both groups. Median treatment duration was similar (7 vs 6 days). Provider-documented UTI diagnoses were common (80% vs 84%); however, only a portion met standardized UTI definitions (IDSA criteria: 41% compliant vs 32% noncompliant), with greater concordance observed among compliant samples. Conclusion: Recommended urine collection practices were followed in just over half of samples, with similar urine test positivity across compliance groups. Differences in organism distribution, antimicrobial prescribing, and concordance between provider-documented and standardized UTI diagnoses suggest that urine collection practices may influence diagnostic classification and antimicrobial decision-making in hospitalized adults.

Background: Central line-associated bloodstream infections (CLABSIs) remain a significant source of preventable harm in hospitalized patients, often resulting from missed dressing changes and mislabeled tubing. Research indicates that most CLABSIs occur more than five days after catheter insertion, highlighting the importance of maintenance practices. This project, conducted at Atrium Health Union/Union West, aimed to reduce CLABSI rates by improving adherence to central line care protocols through innovative use of secure chat photography. Methods: Using the Plan-Do-Study-Act (PDSA) framework, the team identified procedural gaps in dressing changes and tubing labeling. A novel intervention was implemented: frontline nurses sent secure chat photos of central line dressings and tubing labels to leadership at each shift change via the electronic medical record (EMR). This real-time visual verification system enhanced compliance monitoring and accountability. Stakeholder engagement was prioritized through shared governance, pilot testing, and feedback loops. Pre- and post-intervention audits measured compliance, and statistical analysis validated the impact. Results: Pre-intervention compliance with central line maintenance protocols was 83%. Post-intervention, compliance improved to a range of 92.4% to 100% across seven units, averaging 95.5% with sustained results for a year thus far. This improvement correlated with a reduction in CLABSI rates, contributing to better patient outcomes and potential cost savings, as each CLABSI can cost between $16,000 and $45,000. The project is on track to meet its goal of ≥99% compliance, supported by ongoing audits, leadership feedback, and integration of the secure photo process into standard workflows. Conclusion: This initiative successfully leveraged digital tools to address a persistent clinical challenge. Secure photo documentation via EMR messaging proved to be an effective, scalable, and low-cost strategy for improving central line care compliance. The intervention not only enhanced patient safety and reduced infection risk but also promoted health equity by standardizing care across units. Its replicability across other healthcare settings makes it a valuable model for broader dissemination. The project demonstrates how technology-driven solutions can transform infection prevention practices and support institutional goals of safety, quality, and equity in care delivery.

Background: Central line-associated bloodstream infections (CLABSIs) remain a challenge in pediatric intensive care units (PICUs); central line days have been directly correlated with risk of CLABSI. The Mayo Clinic PICU is a 23-bed multidisciplinary unit including dedicated bone marrow transplant beds with an average of 1048 admissions annually. In 2024, the unit’s CLABSI rate was 0.82 per 1,000 central line days or approximately 1–3 CLABSIs per year. Weekly multidisciplinary CLABSI Prevention Rounds were piloted from August 2024 to March 2025 with the aim of reducing central line device utilization rate as a method to reduce CLABSI risk. Methods: A multidisciplinary team of Clinical Nurse Specialists (CNS), Nurse Managers, and off-service PICU physicians conducted weekly CLABSI rounds on PICU beds (excluding 4 BMT beds), meeting with each bedside nurse as well as the on-service providers. The CLABSI team assessed central line necessity using a standard questionnaire and provided education to physicians and nurses regarding central line care and CLABSI prevention. Monthly data were compared for the same 8 calendar months pre versus post intervention for central line days, patient days, and device utilization rate (DUR; central line days/patient days), both unadjusted and adjusted for PRISM (Pediatric Risk of Mortality) 3 severity of illness score. Pre- and post-implementation staff surveys assessed confidence in line management and interdisciplinary communication using Likert scales. Results: Thirty-two CLABSI rounds with a total of 118 individual patients and 45 discrete interventions were noted over 8 months and compared to the 8 pre-intervention corresponding months. Pre versus post monthly DUR was 0.42 [0.32–0.57] vs 0.46 [0.30–0.55], p = 0.49 (PRISM 3–adjusted p = 0.97). Nursing confidence in ‘discussing central line need’ significantly improved post-implementation, 5 [4–5] vs 5 [5–5], p = 0.035. Nurses also positively perceived third-party involvement in need assessment, 4 [3–4] vs 4 [3–4], p = 0.06. All surveyed clinicians trended toward being less likely to think a central line was left in too long, 3 [3–4] vs 3 [2–4], p = 0.06. Conclusion: Structured weekly multidisciplinary CLABSI rounds are a feasible intervention that empowers bedside nurses and improves confidence in line maintenance and interdisciplinary communication. Median DUR was not significantly altered by the intervention, but nursing perception of central line management improved qualitatively in pre- versus post-implementation surveys. Continued expansion of multidisciplinary initiatives addressing central line necessity and management is needed to further evaluate overall effects on DUR and CLABSI incidence.

Background: Central line-associated bloodstream infection (CLABSI) is one of the four most common healthcare-associated infections worldwide and often results in serious consequences, including prolonged treatment duration, increased antibiotic usage costs, and higher mortality risk. In Vietnam, the CLABSI rate in intensive care units (ICUs) remains high, ranging from 5 to 10 episodes per 1,000 central venous catheter (CVC)-days. Therefore, implementing a CLABSI prevention bundle in ICUs is urgently necessary to ensure patient safety. Methods: A CLABSI prevention bundle was developed, consisting of an insertion bundle and a maintenance care bundle. Training and implementation were conducted in three ICU units: Neurosurgical ICU Dept. (NsICU), Internal Cardiology Dept. (IC), and Cardiac surgery resuscitation Dept. (CSR) from February to September 2025. External audits were conducted on all CVC insertion cases and 5% of CVC maintenance care opportunities in the three departments. Results: The total number of insertion bundle observation opportunities in NsICU, IC, and CSR were 67, 35, and 43 respectively, with average compliance rates increasing over time as follows: 96.76% (range 91.67–100%), 89.46% (range 79.63–95.83%), and 97.18% (range 85–100%). The total number of maintenance care observation opportunities in NsICU, IC, and CSR were 86, 63, and 53 respectively, with average compliance rates over time increasing as follows: 78.07% (range 70–87.5%), 87.75% (range 75–100%), and 82.41% (range 72.73–100%). Despite this, there were certain periods with low compliance rates for both the insertion and maintenance care bundles, particularly in areas such as proper hand hygiene procedures, insufficient antiseptic contact time, and non-compliance with drying time requirements. The average CLABSI rates post-intervention compared to pre-intervention in NsICU, IC, and CSR decreased from 2.38 to 1.6 (P=0.54), from 3.15 to 2.57 (P=0.68), and from 2.4 to 2.02 (P=0.75), respectively. Conclusion: The initial implementation of the CLABSI prevention bundle in three clinical departments led to progressively improved compliance with both CVC insertion and maintenance care practices, contributing to a reduction in CLABSI rates compared to the pre-intervention period.

Background: One intervention to decrease central line associated bloodstream infections (CLABSI) standardized utilization ratios (SIR) is to decrease use of central lines. Central line use can be measured using the standardized utilization ratio (SUR), calculated by the National Healthcare Safety Network (NHSN). Unlike the SIR, decreasing the SUR all the way to zero is not an achievable goal; some patients need to have a central line for their treatment. The objective of this project was to identify a target SUR value to help reach SIR goals. Methods: A midwestern healthcare system set their CLABSI SIR goal at 0.5. Using paired SUR and SIR data from 6 large hospitals from July 2019 through February 2025, six machine learning methods (4 parametric, 2 non-parametric) were applied to determine the SUR required to achieve the goal SIR. The six individual model–recommended SUR values were combined using bootstrap resampling: drawing 1,000 samples (with replacement) from the six SUR estimates, computing the mean each time to produce an ensemble recommendation, and then taking the 5th and 95th percentiles of those means as a 90% confidence interval. Results: Over the study timeframe, the aggregated system SUR was 0.742 and aggregated SIR was 0.774 . The comprehensive analysis recommended that the system adopt an SUR target of 0.650 (90% Confidence Interval: 0.645–0.655) to achieve the central line SIR goal (Figure 1). Conclusion: The analysis allowed the healthcare system to set a personalized goal, using data from the member hospitals, for SUR performance. This allowed identification of hospitals that needed to focus on further interventions to decrease central line use, versus those that should pivot their CLABSI prevention interventions to other focuses.

Background: Patients undergoing hepato-pancreato-biliary (HPB) surgery routinely need central venous access for chemotherapy or parenteral nutrition. Common postoperative complications of HPB surgeries include cholangitis and transient bacteremia from biliary tract manipulation. Previous studies have suggested that the National Healthcare Safety Network (NHSN) criteria that designate bacteremia secondary to infections such as cholangitis, may be too strict to account for these situations, resulting in central line associated bloodstream infection (CLABSI) misattribution. Methods: This retrospective study evaluated bacteremia events within 30 days of an HPB surgical procedure among patients ≥ 18 years old at a large academic medical center in the United States. The study period included January 1, 2024 through October 31, 2025. HPB procedures were identified using operative codes mapped to HPB surgeries by NHSN with bacteremia cases identified electronically. CLABSI cases, as established by NHSN criteria, underwent manual chart review to understand the clinical context. Results: There were 1,143 HPB surgeries within the study period. Bacteremia was detected in 35 of them (3.1%). Five of these were ruled in as CLABSI. CLABSIs occurred at an average of 9.6 days postoperatively and 7.6 days after central line placement or access. CLABSIs were due to Enterococcus faecalis, Candida krusei, Prevotella species, Klebsiella oxytoca, and Staphylococcus aureus. Three of the CLABSIs had clinical evidence of cholangitis, but imaging findings were insufficient to meet NHSN criteria for an intraabdominal infection. These cases included transient bacteremia within 24 hours of biliary manipulation (drain placement for a portobiliary fistula, n=1, and drain capping, n=2). The other two CLABSI cases did not undergo biliary manipulation during their hospitalization and had no clear evidence of secondary infection. Conclusion: A substantial number of CLABSIs in HPB surgical patients may represent misattribution. Consideration to the unique infection risks of HPB surgical patients such as transient bacteremia related to drain placement and exchange could minimize CLABSI misattribution in this patient population. Ellsworth, M. G., Ausborn, V., Patel, B., Chang, P., & Ostrosky-Zeichner, L. (2023). 2419. Increasing Misattribution of Bacteremia as CLABSIs by NHSN Definitions: A Tertiary Care Center Perspective. Open Forum Infectious Diseases, 10(Suppl 2), ofad500.2039. https://doi.org/10.1093/ofid/ofad500.2039

Background: Midlines and peripherally-inserted central catheters (PICC) have increased in use due to their ease of insertion, low insertion risk to patients, and relatively low cost. Three common complications are central line-associated bloodstream infection (CLABSI), upper extremity deep venous thrombosis (DVT), and lumen occlusion. The literature reports PICC-associated CLABSI rates of 0.5-2.1 per 1000 catheter days, DVT rates of 1.4 to 9.5%, and lumen occlusion 5 to 16.1%. Both CLABSI and lumen occlusion are more common in multi-lumen than in single lumen (SL) PICC. Our objective is to evaluate the appropriateness of midline and PICC lumen selection, to assess for rates of complication, and to identify targets for clinical decision support intervention. Methods: Setting. This is a retrospective cohort study of adult patients ≥18 y.o. with a midline or PICC placed by the Vascular Access Team (VAT) between 1/1/24 and 6/30/25 at a 500-bed academic safety net and teaching hospital. Data abstraction. Indication for line placement was determined by VAT consultation order or manual chart review. Upper extremity DVT was screened by ICD10 codes and confirmed through manual chart review. CLABSI was determined through cross-reference to National Healthcare Safety Network data. Alteplase administration was used as a surrogate for lumen occlusion. Appropriateness criteria. Appropriateness of midline and PICC lumen selection was determined by adapting the Michigan Appropriateness Guide for Intravenous Catheters and Michigan Multi-Lumen Appropriateness Criteria (Figure 1). Results: Six hundred twelve midline (n=97, all SL) or PICCs (n=515) were placed into 524 patients in the study period (SL PICC, n=213; double lumen [DL] PICC, n=243; triple lumen [TL] PICC, n=59). The indication for line differed based on the line type (Table 1). The majority of midlines (95.9%) and SL PICCs (99.5%) were deemed appropriate; in contrast, 74.1% of DL PICC and 3.4% of TL PICC were considered appropriate. Complications of midline and PICC were rare (CLABSI: 0.19 per 1000 line days; DVT: 1.1%; lumen occlusion: 11.8%). Any complication occurred in 12.9% of cases and was more common in multi-lumen as compared to SL devices (i.e. midline or SL PICC) (19.9% vs 6.1%, P). Conclusion: Opportunities exist to reduce multi-lumen PICC insertion. This may decrease device-related complications. Optimizing lumen selection through clinical decision support may improve patient safety and vascular access outcomes.

Background: Central-line associated bloodstream infections (CLABSI) are defined as bacteremia, or fungemia, in patients with a central intravascular device and no other apparent source of infection. In cases where devices are not removed, treatment of CLABSI involves eradication of intraluminal infection with systemic antibiotics and supratherapeutic concentrations of antibiotics inside the catheter, creating an antibiotic lock. Antibiotic locks can also be used in selected high-risk individuals and those with recurrent CLABSI for prevention. In this review, we evaluated the use of antibiotic locks for the treatment and prevention of CLABSI at South Texas Veterans Health Care System (STVHCS) to assess if use has been in accordance with standard of care. Methods Retrospective data review of STVHCS electronic medical records from 2020-2025. Data collected is limited to age, catheter type, purpose of antibiotic lock (treatment or prevention), organism targeted, antibiotic used for lock, duration, use of systemic antibiotics, and if the intervention was successful at 30 and 90 days. Appropriate lock used was defined as in accordance with the IDSA 2009 CLABSI treatment guidelines, or the 2022 SHEA compendium. Results Data available demonstrated that over the past 5 years there have been 18 instances of antibiotic lock use in 16 patients. Of this population, 13 of 18 lines involved were tunneled hemodialysis catheters with the remaining being ports (3), and tunneled central lines (2). Six of these instances were used for prevention of CLABSI due to long-term hemodialysis catheters/recurrent CLABSI, while the remaining 12 were used as treatment. Per IDSA CLABSI guidelines, removal of a catheter was recommended for 8 of 18 cases, (Staphylococcus aureus, Enterococcus spp., and metastatic infection). Of those cases, 6 patients had removal of catheter, whereas the remaining 2 patients had catheter salvage. The retention of the catheters were in accordance with IDSA guidelines as they received systemic antibiotics with concomitant lock therapy and had no alternative venous access and removal was contraindicated. We found at 30 days, all patients had survived. Whereas at 90 days, 4 patients had expired due to other all-cause mortality and unrelated to recent CLABSI infection. Conclusions Based on this retrospective review, there were 18 instances of antibiotic lock therapy that appeared to be in accordance with clinical guidelines for both prevention and treatment of CLABSI. This data review is part of the antibiotic stewardship program and will be used to develop future quality improvement processes.

Background: Healthcare-associated bloodstream infections (HABSIs) are major cause of morbidity and mortality in intensive care units (ICUs), particularly in low - and middle-income countries (LMICs). However, ICU-level surveillance data describing the epidemiology and antimicrobial resistance pattern of bloodstream infections in Vietnam remain limited. Methods: We conducted a restrospective descriptive study using routine infection prevention and control (IPC) surveillance data from an adult ICU at a tertiary infection diseases hospital in Hanoi, Vietnam. All laboratory-confirmed HABSI episodes recorded between October 2023 and December 2025 were included. Cases were identified using standardized national IPC surveillance definitions aligned with CDC/NHSN principles. Demographic characteristics, exposure to invasive devices, microbiological profiles and antimicrobial resistance patterns were analyzed. Results: A total of 134 HABSI episodes were identified. Male patients accounted for 73.9% (99/134) of cases. Most infections occurred among critically ill ICU patients with prolonged ICU stays and exposure to invasive devices. Central venous catheters were present in the majority of HABSI episodes 84.3% (113/134), suggesting a high level of exposure to intravascular devices. Gram-negative organisms predominated (82 episodes) with Acinetobacter baumannii was the most frequently identified pathogen (20.9%), followed by Klebsiella pneumoniae (15.7%) being the most frequently isolated pathogens. A high proportion of isolates demonstrated multidrug resistance, with 67.1% (55/82) of gram -negative isolates exhibiting carbapenem resistance, predominantly a mong A.baumanii and K.pneumoniae . In addition, fungal bloodstream infections due to Candida species accounted for 30 episodes (22.4%). Conclusion: HABSI in this adult ICU were associated with frequent central venous catheter use and a high burden of antimicrobial resistance, particularly carbapenem-resistant gram-negative bacteria dominated by Acinetobacter baumanii. The substantial proportion of candidemia further highlights the complexity of bloodstream infections in critically ill patients. These findings underscore the importance of strengthening facility-based IPC surveillance, optimizing central line care practices, and integrating stewardship interventions in high-risk ICU settings in Vietnam.

Background: Central line-associated bloodstream infections (CLABSIs) remain a challenge in pediatric care, particularly among medically complex patients requiring prolonged catheterization. Critically ill and immuno-compromised patients maintain high CLABSI rates despite robust efforts to reduce infections. A multifaceted approach to prevention is required, including evidence-based practice standards, competency evaluation, and bundle reliability. Objective: To establish adherence to evidence-based practice standards and evaluate competency. Design/Methods: A structured, multi-unit competency module was developed, emphasizing five core domains of central venous catheter (CVC) care including: sterile dressing changes, timely and aseptic needleless connector changes, standardized use of CVC coverings and securement devices, evidence-based lab-drawing procedures, and skin and environmental hygiene practices; including bathing, room cleanliness and linen management. Staff completed return demonstrations and direct observation audits from March 2024 to March 2025. Units were determined based on NHSN Targeted Assessment Prevention (TAP) report targeting locations with the greatest need. Baseline (January 2023-Febuary 2024) and post-implementation (April 2025 – December 2025) CLABSI rates per 1000 catheter days were measured. Concurrent to the competency, additional interventions included: web-based learning on CVC dressing, chlorhexidine treatment campaign and enhanced visual displays, development and use of high-risk CLABSI reports, and creation of an infection prevention committee in oncology. Results: Three units were identified for the intervention from March 2024 to March 2025, including our medical-surgical intensive care unit (ICU), Hematopoietic Stem Cell Transplant Unit (HSCT), and hematology/oncology. During demonstration, corrections were made on practices, resulting in improved adherence to key CVC maintenance practices, with the most significant improvements seen in dressing and needleless connector change technique and lab-drawing asepsis. From observation, skin and environmental hygiene practices also improved, supporting a need for a comprehensive approach to CLABSI prevention. The overall CLABSI rate for these units decreased from 1.1 pre-intervention to 0.55 post intervention (excluding the intervention period). Most notably, the HSCT unit decreased their CLABSI rate by 100% with zero CLABSIs since intervention resulting in a shift in the mean, and the MSICU saw a 60% reduction.Conclusions: A back-to-basics CLABSI competency and other prevention interventions effectively reinforced essential CVC care practices and improved standardization across inpatient units. Re-establishing core competencies paired with direct observation and environmental hygiene reinforcement, supports sustained reductions in CLABSI risk and strengthens a culture of line safety. Continued monitoring and annual competency refreshers are recommended to maintain practice reliability. Keywords: CLABSI, pediatric oncology, pediatric intensive care, quality improvement, infection prevention

Authors and Affiliations: Frank Frankovsky III, Thane Thomas, Mark Sigler, MD, Joshua Preator, DO, James Morris, MD, MPH, FACEP, Jennifer Clary, MSN, RN, CIC, Stephanie Stroever, PhD, MPH Background: Healthcare Infection Control Practices Advisory Committee (HICPAC) guideline 2.2.11 recommends replacement of central venous catheters inserted emergently under non-sterile conditions as soon as possible and ideally within 48 hours. The extent of compliance with this recommendation and associated outcomes in emergency department (ED)–placed central lines remains unstudied. Methods We conducted an observational study of adult patients admitted following central line placement in the ED at two hospitals in West Texas between June 2024 and August 2025. Patients who died in the ED were excluded. The primary outcome was time to central line removal or replacement after admission. Central lines were classified as emergent (non-sterile) if placed without maximal sterile barrier precautions and documented as such in a standardized ED log. Conditions of line placement were verified by investigator chart review and, when necessary, direct discussion with the team involved in placement. Patient demographics, indications for line placement, and clinical outcomes were abstracted from the medical record. Median time to removal or replacement was calculated for sterile and non-sterile lines and compared using the Wilcoxon rank-sum test; p-values <0.05 were considered statistically significant. Sensitivity analyses excluded patients who died after hospital admission. Results A total of 284 patients were included, of whom 121 (42.6%) had non-sterile central lines placed. Mean age was 64.5 years, with similar distribution by sex. Common indications for line placement included altered mental status (24.3%), cardiac arrest (19.0%), and shortness of breath (14.8%). Median time to removal/replacement was shorter for non-sterile lines than sterile lines (56.2 vs 90.7 hours; p = 0.038). This difference was not observed in sensitivity analyses excluding patients who died after admission (p = 0.775), suggesting survivorship or competing risk bias. No central line–associated bloodstream infections (CLABSI) were identified. Conclusion No CLABSI events were observed despite median central line dwell times exceeding the 48-hour threshold referenced in HICPAC guidance. Early mortality among patients with emergently placed lines may have limited the opportunity for infection to occur. These findings emphasize the role of concurrent infection prevention measures and highlight the need for multidisciplinary strategies to support timely replacement of emergently placed central lines.

Background: Vascular access devices (VAD), including central venous catheters (CVC) and peripheral intravenous catheters (PIVC), are among the most common medical intervention for hospitalized patients, yet they are also a major source of infectious and noninfectious complications. The Centers for Disease Control and Prevention (CDC) recommends prompt removal of CVC that are no longer indicated as a cornerstone of CLABSI prevention, although cessation of CVC indication is ill-defined. Our hospital implemented a Device Stewardship program to identify VAD that were likely inappropriate and to nudge providers to remove them promptly. The objective of this study is to quantify the opportunities to decrease VAD utilization and to describe early Device Stewardship efforts. Methods Study design and population. This is a retrospective cohort study at a 500-bed academic safety net hospital in Denver, CO. All inpatients hospitalized between 10/1/2025 and 12/31/2025, were eligible for inclusion. CVC placed for ECMO or rapid rewarming were excluded. Definitions. The following VAD were generally considered unnecessary: Femoral triple lumen catheters (TLC) in place for <1 day TLC present in a patient on an acute care unit Duplicate VAD (peripherally-inserted central catheter [PICC] and PIVC) in a patient on an acute care unit Intervention. Infection preventionists (IPs) identified eligible patients through an Epic worklist. Standardized text messages were used to suggest de-escalation of VAD to nursing and provider teams on weekdays (Figure 1). Results There were 576 TLC device days and 871 PICC device days in hospitalized inpatients during the study period. VAD selection could be improved in 29.6% of these patients (Table 1). Duplicate VAD was identified as the most frequent opportunity for improvement whereas femoral TLC present for <1 day was the least frequent opportunity. IPs contacted the clinical teams of 64 unique patients with duplicate VAD to suggest removal of ≥1 PIVC; 36 PIVC in 25 patients (39%) were removed as a result of intervention. Additionally, 5 femoral TLC present for <1 day and 15 TLC on acute care units were intervened upon with 1 femoral line and 3 TLC (20% each) removed during the study period. Conclusion Despite national guidelines to remove unnecessary VAD, there is ample opportunity to deescalate VAD in clinical practice. Simple criteria can be developed to standardize the selection and to prompt earlier removal of VAD, particularly duplicate access. Work can be done to improve the acceptance rate of suggestions.

Background: PNGS technology to identify microbial DNA in blood, is used to diagnose infections not identified with standard cultures. The National Healthcare Safety Network (NHSN) defines central line associated bloodstream infection (CLABSI) as an NHSN defined laboratory confirmed bloodstream infection (LCBI) in the presence of an eligible central line. The LCBI definition was updated in 2020, to include pNGS as a non microbiologic test to define CLABSI, not accompanied by a standard blood culture. This study describes the adverse impact of pNGS on CLABSI rates at a pediatric hospital. Methods: CLABSI events attributed to pNGS results, were identified through hospital infection control records from January 2020 through June 2025. Medical charts were reviewed for blood cultures, indications for testing, prior pNGS, and changes in antimicrobial therapy based on pNGS results. CLABSIs associated with mucosal barrier injury (MBI) were not included as these are not part of nationally reported rates. Results: 138 eight CLABSI events were identified during this timeframe, with 21(15.2%) defined by pNGS results. CLABSI rates are shown in the Table. Of pNGS defined CLABSI events, 11 patients had sites of infection other than blood, and 6 had pNGS done only to follow up prior pNGS results. Eight children with organisms identified on pNGS were already being treated and 8 new organisms on pNGS results were considered not clinically significant and not treated. Antimicrobial therapy was given in response to pNGS results for 5 patients: a neonate with candida and ureaplasma on pNGS, a pancreatitis patient with Enterococcus avium and Staphylococcus epidermidis on pNGS, a patient started on ganciclovir due to CMV, and 2 patients treated for organisms on pNGS associated with previously identified non bloodstream infections. Conclusion: Inclusion of pNGS defined CLABSI events increased reported CLABSI rates by a mean 19.2% per year. Most pNGS results were associated with non bloodstream infections. The clinical significance of pNGS results is uncertain and positive results do not correlate with bacterial bloodstream infections. PNGS results should not be considered comparable to traditional blood cultures and should not be used to define CLABSI events.

Background: Patients in the intensive care unit (ICU) often require two concurrent central venous catheters (CVCs) – a temporary CVC for medication administration and a hemodialysis (HD) catheter (HDC). Having concurrent CVCs increases the risk of central line-associated bloodstream infections (CLABSIs). Triple-lumen HDCs have an additional lumen, which may reduce the need for concurrent CVCs as compared to double-lumen HDCs. We evaluated CVC utilization and prevalence of concurrent CVCs in patients with HDCs in an academic ICU after implementing triple-lumen HDC use. Methods: We analyzed data from patients with newly placed HDCs, admitted to a 20-bed medical ICU in an academic hospital in Atlanta, GA from November 2022-January 2025. Triple-lumen HDCs were introduced February 2024. Data were obtained from the electronic health records. Concurrent CVC was defined as having a newly placed HDC and any other simultaneous CVC for at least one calendar day during the ICU admission. Central line-days were defined as number of CVCs in place per 1000 patient-days and lumen-days were defined as number of lumens in place per 1000 patient-days. We analyzed CVC and lumen utilization and prevalence of concurrent CVCs after the intervention by interrupted time series analysis (ITS). ITS with Poisson regression determined if there was a decrease in lumen-days or admissions with concurrent CVCs in the post-intervention vs. pre-intervention time period. An exploratory analysis compared the number of CLABSIs (as defined by NHSN) pre- and post-intervention. Results: Conclusion: After the introduction of triple-lumen HDCs to an academic medical ICU, the total prevalence of patients on HD requiring concurrent CVCs decreased, however our sample size was too small to demonstrate statistical significance by ITS. Decreasing the need for concurrent CVCs may reduce CLABSIs in this ICU but additional time post-intervention is needed.

Background Central-line–associated bloodstream infections (CLABSIs) are healthcare-associated infections occurring in critically-ill patients where central veins are accessed using central venous catheters (CVCs). Use of antimicrobial CVCs has been recommended to reduce CLABSI rates in acute care settings. 1 Reducing CLABSI rates in community hospitals remains a challenge due to variability in the type of CVC used, CVC bundle compliance, interdisciplinary collaboration, and overall culture related to central line (CL) use. Methods A quality improvement project (QIP) conducted at two acute care community hospitals evaluated the impact of standardized CL insertion bundle, interdisciplinary collaboration, and shared accountability on CLABSI rates. The QIP was conducted at facilities, A and B, within the same hospital system, from October 2018–September 2025, where both facilities used a CVC kit containing a silver-platinum-carbon (SPC)-impregnated CVC for vascular access. From January 2020–June 2024, in addition to the CL kit, key interventions implemented sequentially included daily infection prevention (IP) emails regarding CL status; multidisciplinary CLABSI rounds to discuss CL indications/culturing practices; chlorhexidine gluconate (CHG) bathing documentation transition to medical administration records; optimization of CVC device maintenance order placement in an electronic health record system; initiation of CHG/isopropyl alcohol device swab for hub scrubbing for all CL access; and blood cultures ordered through a care pathway incorporating blood culturing stewardship. CLABSI rates were calculated in terms of events per 1,000 CL days to assess the impact of these interventions on CLABSI prevention. Results The post-intervention CLABSI rate for Facility A was significantly lower than the pre-intervention rate (0.100 vs 0.728; P = 0.0409). The post- and pre-intervention CLABSI rates for Facility B were 0.494 and 0, respectively; although clinically significant, no statistical difference in rates was observed (P = 1). For both facilities, the observed monthly CLABSI rates exhibited a gradual long-term decline without significant impact of specific interventions. The decline was statistically significant for Facility A (P = 0.00992) whereas for Facility B the decline was non-significant (P = 0.152). Conclusions Continuous implementation of the SPC-impregnated CVC-containing kit likely established a stable baseline for infection prevention. Subsequent interventions did not result in statistically significant changes in monthly CLABSI rates, suggesting gradual improvements attributable to ongoing process maturation rather than discrete intervention effects. References

Background: The clinical indication for vascular access devices (VAD), including central venous catheters (CVC) and peripheral intravenous catheters (PVC), should be assessed daily. If VADs are no longer indicated, they should be removed to reduce the risk of catheter-associated bloodstream infections (CABSI). In 2030, the CDC’s National Healthcare Safety Network (NHSN) will adopt a new metric for BSI surveillance called Hospital Onset Bacteremia (HOB) which is device agnostic. In this framework, all VADs, not just CVCs, will be considered potential causes of BSIs. We determined that unnecessary VAD use was increasing the hospital’s CLABSI rate, particularly in non-ICU units. We partnered with the Patient Safety Committee and the Mission Control (MC) center to develop an intervention, called MC-CABSI, to encourage prompt removal of unnecessary VADs. Methods: We developed five messages to communicate with patient care teams via our EHR’s secure chat, using data sourced from nursing flowsheets. The first, “Central Line Not Infusing,” tracks CVCs without documentation of infusion in the last 48 hours. The second and third are “Central Line and Two or More PVCs” and “Three or More PVCs,” respectively. These messages indicate high Vascular Access Device Density (VADD), defined as a unit’s median VAD days, including both CVCs and PVCs. The VADD accounts for multiple devices in a given patient, unlike the Standardized Utilization Ratio currently used for CLABSI reporting. The fourth message is “Central Line Not Meeting Necessity,” indicating a CVC documented as no longer indicated, but has not been removed. The fifth category is for any “Field-Inserted PVC,” present <24 hours after admission. Our policy requires such PVCs be removed due to the likelihood they were placed in sub-optimal conditions. Messages are sent by two infection preventionists daily and include one nurse and Attending. Result: We have sent 253 messages since the intervention began July 2025, and care teams responded by removing ≥1 CVC or PVC from 145 patients (57% response rate). Hospital-wide VADD has decreased from 1.40 to 1.33 over this time compared to the previous six months. Conclusion: Dialogue with care teams has been collaborative, with many expressing gratitude for this effort. As the intervention matures, we intend to track results, dialogue with providers, and hone messaging to improve outcomes. We see potential to expand the real-time feedback to cover other devices like indwelling urinary catheters. We also see opportunity for automation to improve scalability in preparation for the shift to HOB surveillance.

Background: Nasal colonization with Staphylococcus aureus is a well-established risk factor for central line–associated bloodstream infections (CLABSIs). Many institutions have adopted screening and targeted decolonization strategies using intranasal mupirocin; however, real-world implementation remain incompletely characterized. Methods: We conducted a retrospective cohort study at University Hospitals Cleveland Medical Center to evaluate implementation of S. aureus screening and decolonization protocol among hospitalized adults undergoing central venous catheter (CVC) or peripherally inserted central catheter (PICC) placement. All patients aged ≥18 years admitted between October 1, 2023, and May 5, 2025, who had a catheter placed were included. Patients with documented bloodstream infection at the time of catheter placement were excluded. Primary implementation outcomes were: (1) proportion of patients screened for S. aureus colonization, and (2) proportion of colonized patients who received prophylactic intranasal mupirocin. Secondary outcomes included overall mupirocin use, bloodstream infection (BSI), and CLABSI rates. Mixed effects logistic regression was performed to identify factors associated with screening uptake. Results: Among 11,107 central lines placed, 63.4% underwent S. aureus screening. Of those screened, 22.6% tested positive for Staph aureus. Only 21.2% of colonized patients received intranasal mupirocin, corresponding to an overall mupirocin use rate of 5.3%. Across all central lines placed during the study period, the overall BSI and CLABSI rates were 0.91% and 0.67%, respectively. In adjusted analyses, screening was more likely among patients with arm insertion sites (OR 1.68, 95% CI 1.34–2.12), left-sided catheter (OR 1.18, 95% CI 1.07–1.29), increasing catheter lumens (three lumens: OR 1.27, 95% CI 1.11–1.47; four lumens: OR 2.22, 95% CI 1.58–3.12), ICU location (OR 1.66, 95% CI 1.49–1.84), and hematology–oncology services (OR 1.51, 95% CI 1.12–2.03). Although catheter type itself was not independently associated with screening, patients receiving PICCs demonstrated a positive, though non-significant, trend toward higher screening uptake compared with CVCs (OR 1.15, 95% CI 0.91–1.47). Tunneled catheters (OR 0.87, 95% CI 0.79–0.97) and a higher number of prior inpatient admissions were associated with lower odds of screening, while demographic characteristics and most comorbidities were not. Conclusions: S. aureus screening uptake among patients with central lines was low, and gaps at subsequent steps in the process resulted in fewer than one quarter of colonized patients receiving mupirocin. This stepwise breakdown in implementation highlights opportunities to improve protocol reliability by reducing decision points through more standardized approaches.

Background: Central-line-associated bloodstream infections (CLABSI) are a costly yet preventable healthcare-associated infections, contributing to increased morbidity and mortality. We describe the impact of a multidisciplinary multi-faceted approach on CLABSI rates at our institution. Methods: This is a pre—post quasi-experimental retrospective study across an 877-bed, quaternary care academic hospital in Southeast Michigan. The CLABSI rate per 1,000 central-line days, blood culture (BC) order rate per 1,000 patient days, standardized infection ratio (SIR) and standardized utilization ratio (SUR) in the pre-intervention period (1/2023-6/2024) to the post-intervention period (9/2024-8/2025) were compared. CLABSI was determined using National Healthcare Safety Network criteria. The multi-faceted intervention comprised of: (1) implementation of a diagnostic stewardship guideline with an algorithm-based approach to improve appropriate blood-culture ordering; (2) prompt notification of CLABSI-eligible patients to facilitate early evaluation for secondary sources; and (3) use of an electronic central line indications checklist to promote early removal of unnecessary lines, supported by an interprofessional stakeholder meeting in June 2024 that designated unit-level champions for execution and feedback. Results: The CLABSI rate significantly decreased from 1.604 to 1.044, resulting in a 35% reduction (p<0.017) [Table]. The SIR significantly decreased from 1.315 to 0.857, a 35% reduction (p=0.011). The SUR significantly decreased from 0.911 to 0.832, a 9% reduction (p<0.001). The BC order rate per 1,000 patient days decreased from 89.2 in the pre-intervention period to 70.7 post-intervention, a 21% reduction (p<0.001). Discussion: A significant reduction in CLABSI rates, central-line utilization, and blood-culture orders was observed following implementation of a multi-faceted approach supported by multidisciplinary collaboration. These findings demonstrate that a coordinated bundled strategy, executed in close collaboration with primary clinical teams, can significantly reduce CLABSI burden in a large academic medical center.