Brief Report A comparison of the incidence of midline catheter-associated bloodstream infections to that of central line-associated bloodstream infections in 5 acute care hospitals Nancy J. Hogle MPH, RN, CIC a, *, Krystal M. Balzer MSN, RN, CIC a , Barbara G. Ross MS, RN, CIC, FAPIC a , Lorelle Wuerz PhD, RN, VA-BC, NEA-BC b , William G. Greendyke MD a,c , E. Yoko Furuya MD, MS a,c , Matthew S. Simon MD, MS a,d , David P. Calfee MD, MS a,d a Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY b Center for Professional Nursing Practice, NewYork-Presbyterian, New York, NY c Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY d Department of Medicine, Weill Cornell Medicine, New York, NY In a retrospective study conducted over 12 months in a multi-hospital system, the incidence of bloodstream infections associated with midline catheters was not significantly lower than that associated with central venous catheters (0.88 vs 1.10 infections per 1,000 catheter-days). Additional research is needed to further characterize the infectious risks of midline catheters and to determine optimal strategies to minimize these risks. © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Key Words: Intravenous therapy Blood stream infection Bacteremia Intravascular catheter Despite notable success in reducing the incidence of central line- associated bloodstream infections (CLABSIs) over the past several years, CLABSIs continue to be a cause of substantial morbidity, mortality, and excess health care costs in US hospitals. 1, 2 One important strategy for CLABSI prevention is avoidance of unnecessary use of central lines (CLs). 3,4 Midline catheters (MLs) are intravenous (IV) catheters that are inserted into peripheral veins. Although they are of variable length, they are typically longer than standard peripheral IV catheters yet do not enter the center venous system. These catheters may remain in place and functional for longer periods of time than standard peripheral IV catheters; therefore, MLs may be an appropriate alternative to CLs for some patients who do not require central access. 5 Currently, surveillance and reporting of midline catheter-associated bloodstream infections (MLABSIs) are not required, in contrast to CLABSI. Some hospitals have reported lower rates of CLABSI following implementation of a ML pro- gram; however, few have assessed the incidence of MLABSIs. 6, 7 Given that hospitals may increasingly use MLs as alternatives to CLs and that the incidence of bloodstream infections (BSIs) associated with the use of MLs has not been thoroughly studied, we sought to determine the inci- dence of MLABSIs after their introduction in a multi-hospital system. METHODS This was a retrospective surveillance study conducted in the 5 acute care hospitals of a large urban medical system from September 2016 to August 2017. The 5 hospitals include 2 large academic ter- tiary care hospitals, 2 small community hospitals, and an academic pediatric and women’s hospital. Combined, the 5 hospitals have approximately 2,200 staffed beds. This study was approved by the Weill Cornell Medicine Institutional Review Board and the Columbia University Irving Medical Center Institutional Review Board. The hos- pital system had introduced PowerGlide MLs (Bard Access Systems, Inc.; Salt Lake City, UT) as an option for venous access between June and August 2016. The MLs were ordered by a clinician, placed by trained vascular access personnel, and maintained by either the vas- cular access team or the patient’s bedside nurse. MLs were placed using a skin prep containing alcohol and chlorhexidine gluconate (CHG), sterile gloves, and sterile techniques, and a Tegaderm CHG dressing (3M; St. Paul, MN) was applied to the insertion site. During the study period, peripherally inserted central catheters were inserted by trained vascular access nurses or physicians in pro- cedural areas (eg, interventional radiologists), and other non-tun- neled and tunneled central venous catheters were placed by trained physicians, physician assistants, and nurse practitioners following a standardized protocol across all sites based on current evidence- based practice guidelines. 3,4 *Address correspondence to Nancy J. Hogle, MPH, Cleveland Clinic, 9500 Euclid Ave, JJN2-200, Cleveland, OH 44195. E-mail address: nancyhogle@gmail.com (N.J. Hogle). Conflicts of interest: M.S.S. reports personal fees from Roche Diagnostics, outside the submitted work. All other authors report no conflicts of interest. https://doi.org/10.1016/j.ajic.2019.11.004 0196-6553/© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. ARTICLE IN PRESS American Journal of Infection Control 000 (2019) 1-3 Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org