Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes?

During the past 8 years my research interests have changed from a focus on tick-borne disease and endocarditis to a primary focus on healthcare-associated infections (HAIs). Specifically, I have been interested in HAIs in community hospitals. Using prospective data collected as part of our surveillance activities in the Duke Infection Control Outreach Network (DICON), I and my colleagues have focused on these specific areas of research:

• The accuracy and reliability of surveillance definitions used to document and trend rates of HAIs
• Outcomes of HAIs (both financial and clinical) with particular emphasis on bloodstream and surgical site infections
• Trends in HAIs due to pathogens resistant to common antimicrobial agents
• Temporal and geographic variations in the occurrence of pathogens such as methicillin-resistant S. aureus, E coli and Klebsiella pneumonia
• The prevention and control of HAIs with particular emphasis on the potential role of the environment in the transmission of HAIs

As the principal investigator on one of the 5 national epicenter grants funded by the Centers for Disease control I, along with my co-investigators from the Duke and University of North Carolina Division of Infectious Disease, are involved in a 5-year prospective study of the potential benefit of enhanced cleaning methods (such as the use of ultraviolet light emitters) in the prevention of HAIs. This study involves 9 hospitals in North Carolina and Virginia and will include a trial of 4 different cleaning methods utilized sequentially but randomly in these study hospitals over a 28-month time period. Additionally the Duke Epicenter is also undertaking prospective trials investigating the utility and reliability of new (streamlined) definitions of ventilator-associated pneumonia.


Key words that characterize my work: surgical site infections and nosocomial infections.

Hospital epidemiology, infection control, antibiotic stewardship, multidrug-resistant organisms, device-related infections, surgical site infections, catheter-associated bloodstream infections, cost of infections, infections in community hospitals