Central line-associated bloodstream infections in patients with hematologic malignancies: A quality improvement Initiative

Central line-associated bloodstream infections (CLABSI) are frequent complications in acute leukemia patients. Central lines are often required in this population due to disease trajectory and treatment demands. It is well established within literature that Peripherally Inserted Central Catheters (PICC) when compared to Implanted Venous Access Devices (IVAD) have higher rates of CLABSI and VTE, although some data on VTE have shown no difference between line types. Both CLABSI and line-associated VTE frequently require in-hospital management. In our institution, in patients with acute leukemia, PICC lines are often placed during initial hospitalization and maintained long-term in the outpatient setting. This treatment decision is provider-specific but often utilizes PICC over IVAD.

Retrospective chart review of all inpatient hematology service admissions was performed from January 2023 to September 2024. Patients with a hematologic malignancy and had a PICC line admitted with bacteremia were included.

We identified 80 total patient admissions for bacteremia. During this period, there were total 5,101 line days with a monthly mean 255.05, median 250, and a range 174-364 days. Of the 80 bacteremia admissions, 28 (35%) PICC lines were removed due to bacteremia with only 2 (2.5%) undergoing subsequent IVAD placement and 11 (13.75%) subsequent TVAD placements. Confirmed CLABSI by NHSN definition occurred in 25 (31.2%) admissions, with 14 (56%) of these in acute leukemia patients, and 16 (N=80, 20%) with confirmed bacteremia on admission. Disease breakdown revealed, 37 (46.25%) patient admissions with acute leukemia, 6 (7.5%) ALL and 30 (37.5%) AML and 1 (1.25%) APL. Other myeloid diseases included 1(1.25%) CML, 1 (1.25%) CMML, 2 (2.5%) MDS, 1 (1.25%) MF and 1 (1.25%) myeloid sarcoma. There were also 6 (7.5%) CLL, 29 (36.25%) with Lymphoma (HL and NHL) and 1 (1.25%) MM and 1 (1.25%) sacral mass undiagnosed patient admissions.

PICC lines are associated with high rates of CLABSI. Implementation of an institutional line placement guideline based on literature and society guidelines aims to decrease rates of long-term PICC line use and CLABSI in patients with acute leukemia. The protocol will be implemented in all acute myeloid leukemia (AML) patients admitted to the hospital. After hospital discharge due to line requirements for ongoing treatment, IVAD placement will be coordinated. We plan to monitor the rates of CLABSI and VTE, numbers of PICC and IVADs placed, PICC line days, cost estimates and number of hospitalized patient days associated with management of line associated complications to analyze for quality improvement.