Health Care–Associated Bloodstream Infections: A Change in Thinking

It is not necessary to change. Survival is not mandatory.

—W. Edwards Deming

Nosocomial, or hospital-acquired, bloodstream infections (BSIs) are an important cause of morbidity and mortality, affecting more than 200 000 patients per year in the United States (1). These infections are often associated with the use of catheters. Catheter-related infections make up about 14% of all hospital-acquired infections (2) and are responsible for more hospital days and death than any other hospital-acquired infection (3). Bloodstream infections can be primary or secondary. A primary infection is an infection directly into the vascular system; a secondary infection originates at a site other than the vascular system, such as the urinary tract, respiratory tract, or wounds, and spreads to the vascular system. According to the definitions from the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance (NNIS) System, primary BSIs account for 64% of nosocomial BSIs (2, 4).

“Nosocomial,” “community-acquired,” “bloodstream infections,” and “primary/secondary” are surveillance terms that have stood, essentially unaltered, for almost two decades (4). Yet the health care system has been anything but static during this period. Routine care for patients with serious underlying illnesses and with invasive devices, such as intravascular catheters, has shifted from exclusively acute care settings to nursing homes, rehabilitation centers, free-standing dialysis centers, and homes. Complications of caring for patients with serious illness occur in all of these settings.

In this issue, Friedman and colleagues propose a new classification scheme for BSIs (5). This scheme does not change …