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MBI-LCBI and CLABSI: more than scrubbing the line

Bone Marrow Transplantation volume 54, pages 1932–1939 (2019)Cite this article

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The Hospital-Acquired Conditions Initiative, mandated by Congress and implemented in 2008, was a Centers for Medicare & Medicaid Services (CMS) payment reform intended to improve value and patient safety [1]. The initiative decreased reimbursement rates for patients that developed specific complications during their hospitalization [2]. Central line-associated bloodstream infections (CLABSI) was one of the initial eight hospital-acquired conditions determined to be preventable, based on landmark work showing a reduction of CLABSI by standardization of process and quality improvement. Pronovost et al. showed that adherence with five evidence-based guidelines (hand washing, sterile technique for central line placement, cleaning the skin with chlorhexidine prior to line placement, avoiding femoral site if possible, and discontinuation of unnecessary catheters) was associated with substantial, sustained reductions in CLABSI [3, 4].

Hematopoietic stem cell transplantation (HSCT) is the definitive therapy for many malignancies, marrow failure syndromes, and immune deficiencies in children, adolescents, and adults [5, 6]. Bloodstream infections (BSI) continue to be a significant cause of morbidity and mortality following HSCT, although transplant strategies and supportive care have evolved over the past few decades, resulting in improved overall survival [7,8,9,10,11]. Patients undergoing HSCT are hospitalized for prolonged periods, require complex care, usually have central venous catheters throughout their hospitalization, and are at risk for BSI secondary to contamination of the central line, as well as from translocation of bacteria through a compromised oral and gut mucosa secondary to chemotherapy and radiotherapy [12,13,14]. Shortly after implementation of the Hospital-Acquired Conditions Initiative, physicians caring for oncology and HSCT patients were being held accountable by hospital leadership for CLABSI likely related to treatment-related mucosal barrier injury [15].

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Authors and Affiliations

  1. Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Christopher E. Dandoy & Priscila Badia Alonso

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Christopher E. Dandoy & Priscila Badia Alonso

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Dandoy, C.E., Alonso, P.B. MBI-LCBI and CLABSI: more than scrubbing the line. Bone Marrow Transplant 54, 1932–1939 (2019). https://doi.org/10.1038/s41409-019-0489-1

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