Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies.

To determine nosocomial catheter-associated bloodstream infections (CA-BSIs) and to improve the prevention measures, we performed a prospective surveillance in our hematopoietic stem cell transplantation unit at our university hospital. During the 36-month study period all patients with at least two consecutive neutropenic days (NDs) were included. After the first 18 months the recorded data were analyzed and compared with reference data and were then presented to the clinical staff. An intensive training to improve the handling of central venous lines was performed afterwards. At the end of the last 18-month study period the data were evaluated and a multivariate analysis was conducted. Altogether 268 patients were treated for a period of 10,013 patient days including 4,286 NDs. A total of 202/268 (75.4%) patients underwent transplantation (157/76.6% allogeneic, 48/23.4% autologous). Eighty-seven CA-BSIs were identified. The incidence density was 24.3 CA-BSI episodes per 1,000 NDs in the first period and 16.2 in the second. A significant reduction in the CA-BSI rate of adults was achieved (OR 0.58; 95% CI 0.339-0.987; p < 0.05). Significant risk factors for nosocomial CA-BSIs during the neutropenic phase were AML as underlying disease as well as transplantations.