Indian hospitals are grappling with high rates of dangerous bloodstream infections caused by the mismanagement of central lines—specialized tubes inserted into large veins to deliver medicines and fluids to critically ill patients. A comprehensive seven-year study across 54 hospitals and 200 intensive care units (ICUs) has revealed over 8,600 confirmed cases of these infections, with consequences that include a striking 40% mortality rate within two weeks of infection.

Central line-associated bloodstream infections (CLABSIs) occur when bacteria or fungi enter the bloodstream through these catheters. This problem is particularly acute in neonatal, pediatric, and adult ICUs, where patients often require long-term intravenous access. The study found infection rates of approximately 8.8 cases per 1,000 central line-days overall, with the highest vulnerability among newborns in neonatal ICUs, who experience rates as high as 13.9 infections per 1,000 central line-days. These rates far exceed those reported in developed countries, such as the US, where rates hover below 1 per 1,000 central line-days.

Experts attribute this persistent challenge to several factors: overwhelmed ICUs, shortages of trained healthcare staff, inadequate monitoring and infection control protocols, and the inappropriate use of powerful antibiotics leading to rising antimicrobial resistance. Pathogens such as Acinetobacter and Klebsiella show alarmingly high resistance levels to carbapenems—antibiotics considered last-resort options. Another emerging threat is Candida auris, a drug-resistant fungal pathogen.

“In many government and semi-government hospitals, staff shortages lead to overworked healthcare workers and compromised infection prevention. Central lines often stay in place longer due to the difficulty of repeated needle pricks, especially in pediatric patients, but improper management due to lack of training contributes significantly to infections,” says a leading paediatric infectious disease specialist.

The Covid-19 pandemic worsened the situation as ICUs became overwhelmed, staff shortages increased, and infection control practices were strained. Infection rates peaked during 2020-21 and, although rates dropped slightly afterward, they have since rebounded, highlighting an ongoing systemic issue.

The study underscores the urgent need for improved infection surveillance, workforce augmentation, rigorous antibiotic stewardship, and standardized training programs focused on central line management. Experts call for widespread implementation of quality improvement initiatives targeting prevention of CLABSIs to reduce mortality and improve patient outcomes in India’s critical care settings.

Over 8,600 confirmed CLABSI events recorded across 54 hospitals over 7 years.

Overall infection rate: approximately 8.8 per 1,000 central line-days in ICUs.

Neonatal ICUs show the highest risk, with nearly 14 infections per 1,000 central line-days.

About 40% of patients with these infections die within two weeks.

Pathogens show high resistance to last-resort antibiotics.

Covid-19 pandemic exacerbated infection rates due to overwhelmed healthcare systems.

This alarming data highlights critical gaps in infection control practices in Indian ICUs and calls for coordinated action at institutional and policy levels to safeguard vulnerable patients.