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CATHETER ASSOCIATED BLOOD STREAM
INFECTION (CABSI) SURVEILLANCE
November 2012
Infection Control Unit
Quality in Medical Care Section
Medical Development Division
Ministry of Health
INTRODUCTION
 Regardless of the numerous reports on the adverse
impact associated with the use of catheters as a
vascular access for haemodialysis (HD), Central
Venous Catheters (CVCs) remains as an important tool
in the delivery of adequate dialysis.
 In incident HD patients, CVCs provide an instant
access to the circulation.
 In chronic or prevalent HD patients, CVCs are useful
as a bridging gap for patients who have problems with
poor maturation of their native fistula and while
awaiting fistula maturation.
INTRODUCTION - Cont
 The use of CVCs is associated with a high morbidity,
mortality and increased health care costs due to
infectious complications.
 The risk of infection in CVCs is 5-10 fold higher than
dialyzing with a native fistula or graft(1).
 Vascular access related infection and other
complications frequently result in prolonged
hospitalization and account for more than one third of
the cost of ESRD management.
 The reported mortality rate ranges between 12 to
25.9%
INTRODUCTION - Cont
 Despite numerous attempts to encourage the use of fistula,
the usage of CVCs in the USA remains high with nearly
65% of patients using CVCs at the first outpatient HD
treatment (1)
 The 19th Report of Malaysian Dialysis and Transplant
Registry showed that the prevalence rate of End Stage
Renal Disease has increased from 368 per million
population in 2002 to 900 per million population in 2011.
 The usage of CVC in prevalent or chronic HD patients has
also increased from 3% to 8.1% during the same period.
 This is an underestimation as the predominant usage of
CVCs for HD is in the incident patients.
INTRODUCTION - Cont
 The growing numbers of patients who require
haemodialysis combined with the increasing number
of patients who are unable to use native vascular access
other than a CVC stress the need to monitor the rate of
CABSI and the importance of strategies to prevent it.
OBJECTIVES
General
to assess the rate of CABSI in CVC for HD in MOH
hospitals with the aim to reduce morbidity and
mortality related to CABSI
OBJECTIVES - Cont
Specific:
 To determine the incidence rate of CABSI in CVC for
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HD in selected MOH hospitals
to identify risk factors that predispose patient to
CABSI in CVC for HD
to compare the rate of CABSI among the selected
hospitals
to determine the average catheter days before infection
to determine rate of CVC removal due to infection
METHODOLOGY
Population under surveillance
All patients who has a CVC for HD inserted and
receiving haemodialysis or extracorporeal therapy
in Ministry of Health facilities.
Case Definition
All patients who are currently receiving haemodialysis
receiving haemodialysis or extracorporeal therapy
via CVC in Ministry of Health facilities with CABSI.
CABSI is defined as:
 clinical signs and symptoms of infection (fever, chills
and/or hypotension) AND
 a positive peripheral blood culture AND
 no other apparent source of infection.
Exclusion Criteria
 Patient defaulted treatment more than 72hours from
the last haemodialysis treatment
 Patient from private haemodialysis facility with
evidence of current infection during presentation
 CVC inserted outside MOH facilities
End of Catheter Days
The end of catheter days can be determined through
one of the following:
 Date of discharge (Discharge date from HD facilities
plus 72hours; to allow cases that developed CABSI
within the specified period)
 Date of Catheter removal
 Date of Death
DATA COLLECTION
 All patients who have a CVC inserted for HD will be
identified by a designated personnel .
 Upon insertion of CVC for HD , CABSI Coordinator
(Staff Nurse or Medical Assistant) should fill up :
Surveillance Form For Catheter Associated
Blood Stream Infection In Ministry Of Health
Haemodialysis Facility CABSI/MOH/2012/1
(Appendix I )
DATA COLLECTION - Cont

fill up item A, B, C (1 to 4) - Upon CVC insertion
 fill up item C (5 to 6) - Upon removal of catheter or
discharge (discharge from haemodialysis facility
or died)
 If patient developed infection, proceed to item D and
fill up Surveillance Form For Catheter Associated
Blood Stream Infection In Ministry Of Health
Haemodialysis Facility CABSI/MOH/2012/2 as in
Appendix II
DATA COLLECTION - Cont
 Data to be collected and analyzed by the CABSI
Coordinator on monthly basis.
 CABSI Database (Appendix III to VIII) provided by
the MOH will be used as a tool in analysis. It will
generate results automatically.
 Upon completion, CABSI Coordinator has to fill up
Reporting Form of Catheter Associated Blood
Stream Infection in MOH Haemodialysis Facility
CABSI/MOH/2012/3 as in Appendix IX according to
the results generated from the CABSI Database.
DATA COLLECTION - Cont
 Completed CABSI/MOH/2012/3 form to be verified by
the respective Hospital Nephrologists.
 CABSI/MOH/2012/1 and CABSI/MOH/2012/2 forms
to be kept at respective hospital.
 A completed and verified CABSI/MOH/2012/3 form
to be submitted to the National Secretariat by 10th of
every 2 subsequent month.
 Further reporting and analysis will be performed by
the National Secretariat.
DATA ANALYSIS AND REPORTING
 The Catheter Days will be used as denominators to
calculate the incidence rate of CRBSI in each hospital.
Following data will be collected:
 Monthly catheter days
 Cumulative catheter days
CABSI RATE
Monthly CABSI Rate = No. of CABSI for X Month x 1000
Total Catheter Days for X Month
Cumulative CABSI Rate =Total No. of CABSI for Cumulative Month x 1000
Total Catheter Days for Cumulative Month
Rate for CVC Removal Due to Infection
= No. of CVC Removed Due To CABSI x 100
No. of Patient with CVC
a) Monthly
b) Cumulatively
DATA ANALYSIS AND REPORTING - Cont
 All hospitals should send the aggregated data
(Reporting Form of Catheter Associated Blood
Stream Infection in MOH Haemodialysis Facility
CABSI/MOH/2012/3 ) on monthly basis to the
National Secretariat.
 The data will be analyzed and result will be
disseminated every 6-monthly.
 A yearly report will be published and disseminated to
all the states.
PROCESS FLOW CHART FOR CABSI SURVEILLANCE MANAGEMENT
Patient receiving haemodialysis or
extracorporeal therapy in MOH
facility with existing catheter
[OLD CASE]
APPENDIX VIII
Patient in the facility with
newly inserted catheter
[NEW CASE]
Fill up
CABSI/MOH/2012/1
form (Appendix I)
Calculate the monthly
and cumulative
denominator (catheter
days) at the end of the
month
NO
Development
of Infection
YES
Fill up
CABSI/MOH/20
12/2 form
(Appendix II)
Data
compilation
Fill up CABSI/MOH/2012/3
form (Appendix IX)
Completed
CABSI/MOH/2012/3 form
(Appendix III) to be verified by
Nephrologist
Verified CABSI/MOH/2012/3 form
to be sent to Infection Control Unit,
MOH
Data management
REFERENCE
 United States Renal Data System 2011 Annual Data Report:
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Chapter 2. Clinical Indicators and Preventive Care. USRDS
website: www.usrds.org
Burr R et al. The cost of vascular access infections: three years
experience from a single outpatient dialysis center. Hemodialysis
International 2003;7: 73 -104
Liu JW et al. Nosocomial blood-stream infections in patients with
ESRD; excess length of stay, extra cost and attributed mortality.
Hosp Infect 2002; 50: 224-7
19th Report Of The Malaysian Dialysis & Transplant Registry 2011.
Ed Lim YN, Ong LM, Goh BL. Available on the MSN website:
http://www.msn.org.my.nrr
Deborah Tomlinson et all. Defining Bloodstream Infections
Related to Central Venous Catheters in Patients With Cancer: A
Systematic Review. Available on http://cid.oxfordjournals.org/
An APIC Guide 2000 . Guide to the Elimination of CatheterRelated Bloodstream Infections
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