Central line-associated bloodstream infections outside the intensive care unit: Burden, pathogens, and antimicrobial susceptibility identified through a Victorian surveillance program

BACKGROUND: Prevention of central line-associated bloodstream infection (CLABSI) is a priority in Australian intensive care units (ICUs). However, the epidemiology of CLABSI in non-ICU settings remains inadequately characterised, despite extensive use of central lines beyond the ICU. We aimed to determine CLABSI rates and microbiological aetiology in non-ICU wards and to compare these with corresponding ICU data from Victorian hospitals. METHODS: CLABSI surveillance was undertaken voluntarily in non-ICU wards by Victorian health services between 2014 and 2025, utilising the Victorian Healthcare Associated Infection Surveillance System (VICNISS) CLABSI surveillance module, capturing CLABSI rates per 1000 central line days (CLD) as well as bloodstream infections related to mucosal barrier injury (MBI-BSI), in accordance with CDC/NHSN criteria. Retrospective analysis was performed to determine rates, pathogens, and antimicrobial susceptibility. RESULTS: Sixteen facilities participated in surveillance during the study period. 67 CLABSI events and 66,096 central line days were reported in non-ICU wards (predominantly haematology-oncology), corresponding to a CLABSI rate of 1.01 per 1000 CLD, which was significantly higher than the contemporaneous ICU CLABSI rate of 0.50 per 1000 CLD (IRR 3.13, 95% CI 1.88-5.22, p = 0.000). The most frequent pathogens responsible for non-ICU CLABSI were coagulase-negative Staphylococcus spp., Staphylococcus aureus, and Pseudomonas spp. A large burden of MBI-BSI events (n = 90) were also reported. CONCLUSIONS: CLABSI rates outside ICU are significantly higher than those reported in ICU settings. A substantial burden of CLABSI and MBI-BSI events were identified in haematology-oncology populations, supporting focused surveillance and infection prevention efforts in these high-risk cohorts.