Skip to main content Accessibility help
×
Home
Hostname: page-component-747cfc64b6-hfbn9 Total loading time: 0.199 Render date: 2021-06-14T23:08:08.324Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Central Line–Associated Bloodstream Infection Surveillance outside the Intensive Care Unit: A Multicenter Survey

Published online by Cambridge University Press:  02 January 2015

Crystal H. Son
Affiliation:
Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York
Titus L. Daniels
Affiliation:
Department of Infection Control and Prevention, Vanderbilt University School of Medicine, Nashville, Tennessee
Janet A. Eagan
Affiliation:
Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York
Michael B. Edmond
Affiliation:
Division of Infectious Disease, Virginia Commonwealth University Health System, Richmond, Virginia
Neil O. Fishman
Affiliation:
Division of Infectious Disease, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Thomas G. Fraser
Affiliation:
Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
Mini Kamboj
Affiliation:
Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York
Lisa L. Maragakis
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
Sapna A. Mehta
Affiliation:
Division of Infectious Diseases, New York University Langone Medical Center, New York, New York
Trish M. Perl
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
Michael S. Phillips
Affiliation:
Division of Infectious Diseases, New York University Langone Medical Center, New York, New York
Connie S. Price
Affiliation:
Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado
Thomas R. Talbot
Affiliation:
Department of Infection Control and Prevention, Vanderbilt University School of Medicine, Nashville, Tennessee
Stephen J. Wilson
Affiliation:
Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
Kent A. Sepkowitz
Affiliation:
Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York
Corresponding
E-mail address:

Abstract

Objective.

The success of central line-associated bloodstream infection (CLABSI) prevention programs in intensive care units (ICUs) has led to the expansion of surveillance at many hospitals. We sought to compare non-ICU CLABSI (nCLABSI) rates with national reports and describe methods of surveillance at several participating US institutions.

Design and Setting.

An electronic survey of several medical centers about infection surveillance practices and rate data for non-ICU Patients.

Participants.

Ten tertiary care hospitals.

Methods.

In March 2011, a survey was sent to 10 medical centers. The survey consisted of 12 questions regarding demographics and CLABSI surveillance methodology for non-ICU patients at each center. Participants were also asked to provide available rate and device utilization data.

Results.

Hospitals ranged in size from 238 to 1,400 total beds (median, 815). All hospitals reported using Centers for Disease Control and Prevention (CDC) definitions. Denominators were collected by different means: counting patients with central lines every day (5 hospitals), indirectly estimating on the basis of electronic orders (n = 4), or another automated method (n = 1). Rates of nCLABSI ranged from 0.2 to 4.2 infections per 1,000 catheter-days (median, 2.5). The national rate reported by the CDC using 2009 data from the National Healthcare Surveillance Network was 1.14 infections per 1,000 catheter-days.

Conclusions.

Only 2 hospitals were below the pooled CLABSI rate for inpatient wards; all others exceeded this rate. Possible explanations include differences in average central line utilization or hospital size in the impact of certain clinical risk factors notably absent from the definition and in interpretation and reporting practices. Further investigation is necessary to determine whether the national benchmarks are low or whether the hospitals surveyed here represent a selection of outliers.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below.

References

1. Maki, D, Kluger, D, Crnich, C. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:11591171.CrossRefGoogle ScholarPubMed
2. O'Grady, NP, Alexander, M, Patchen Dellinger, E, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39(suppl):S1S34.CrossRefGoogle ScholarPubMed
3. Scott, RD II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Atlanta: Centers for Disease Control and Prevention, 2009.Google Scholar
4. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.CrossRefGoogle ScholarPubMed
5. Centers for Medicare and Medicaid Services (CMS). Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals. Baltimore: CMS, 2012. http://www.cms.gov/HospitalAcqCond/Downloads/HACFactsheet.pdf. Accessed June 1, 2011.Google Scholar
6. Ten great public health achievements: United States, 2001-2010. MMWR Morb Mortal Wkly Rep 2011;60:619623.Google Scholar
7. Reduction in central line-associated bloodstream infections among patients in intensive care units: Pennsylvania, April 2001-March 2005. MMWR Morb Mortal Wkly Rep 2005;54:10131016.Google Scholar
8. Kallen, AJ, Patel, PR, O'Grady, NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010;51:335341.CrossRefGoogle ScholarPubMed
9. US Department of Health and Human Services (HHS). National Targets and Metrics: Monitoring Progress toward Action Plan Goals: A Mid-Term Assessment. Washington, DC: HHS, 2010. http://www.hhs.gov/ash/initiatives/hai/nationaltargets/index.html#clabsi. Accessed July 14, 2011.Google Scholar
10. Joint Commission. National Patient Safety Goals. Washington, DC: Joint Commission, 2008. http://www.jomtcommission.org/hap_2011_npsgs/. Accessed July 14, 2011.Google Scholar
11. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.CrossRefGoogle ScholarPubMed
12. Centers for Disease Control and Prevention (CDC). Device-Associated Module: Central Line-Associated Bloodstream Infection (CLABSI) Event. Atlanta: CDC, 2011. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed March 1, 2011.Google Scholar
13. Dudeck, M, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) Report, Data Summary for 2009, Device-Associated Module. Atlanta: Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/nhsn/PDFs/dataStat/2010NHSNReport.pdf.Google ScholarPubMed
14. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60:243248.Google Scholar
15. Klevens, RM, Tokars, JI, Edwards, J, Horan, T; National Nosocomial Infections Surveillance System. Sampling for collection of central line-day denominators in surveillance of healthcare-associated bloodstream infections. Infect Control Hosp Epidemiol 2006;27:338342.CrossRefGoogle ScholarPubMed
16. Shelly, MA, Concannon, C, Dumyati, G. Device use ratio measured weekly can reliably estimate central line-days for central line-associated bloodstream infection rates. Infect Control Hosp Epidemiol 2011;32:727730.CrossRefGoogle ScholarPubMed
17. Rettig, SL, Gross, KA, Ditaranto, S, et al. Central line-associated bloodstream infections (CLABSI) in oncology patients: the impact of mucositis on CLABSI rates. In: Society for Healthcare Epidemiology of America 2011 Annual Scientific Meeting. Dallas: Society for Healthcare Epidemiology of America, 2011.Google Scholar
18. DiGiorgio, M, Fatica, C, Oden, MA, et al. Defining preventable catheter associated bloodstream infections in hematology oncology patients: use of a modified definition and its impact on rates and pathogens. In: Society for Healthcare Epidemiology of America 2011 Annual Scientific Meeting. Dallas: Society for Healthcare Epidemiology of America, 2011.Google Scholar
19. Zingg, W, Sax, H, Inan, C. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009;73:4146.CrossRefGoogle ScholarPubMed
20. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol 2007;28:13611366.CrossRefGoogle ScholarPubMed
21. Marschall, J, Leone, C, Jones, M, Nihill, D, Fraser, VJ, Warren, DK. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol 2007;28:905909.CrossRefGoogle ScholarPubMed
22. Marschall, J. Catheter-associated bloodstream infections: looking outside of the ICU. Am J Infect Control 2008;36:e5e8.CrossRefGoogle ScholarPubMed
23. Spencer, A, Sward, D, Ward, J. Lessons from the Pioneers: Reporting Healthcare-Associated Infections. Washington, DC: National Conference of State Legislatures, 2010.Google Scholar
24. Passaretti, CL, Barclay, P, Pronovost, P, Perl, TM; Maryland Health Care Commission Health Care-Associated Infection Technical Advisory Committee. Public reporting of health care-associated infections (HAIs): approach to choosing HAI measures. Infect Control Hosp Epidemiol 2011;32:768774.CrossRefGoogle ScholarPubMed
25. Centers for Medicare and Medicaid Services (CMS). HAC Posting on Hospital Compare. Baltimore: CMS, 2011. http://www.xms.gov/HospitalQualityInits/06_HACPost.asp. Accessed July 1, 2011.Google Scholar
26. New York State Department of Health. Hospital-Acquired Infections: New York State, 2009. Albany, NY: New York State Department of Health, 2010.Google Scholar
27. Consumer Reports. Hospital Rankings. Yonkers, NY: Consumer Reports, 2011. http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings.htm. Accessed July 13, 2011.Google Scholar
17
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Central Line–Associated Bloodstream Infection Surveillance outside the Intensive Care Unit: A Multicenter Survey
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Central Line–Associated Bloodstream Infection Surveillance outside the Intensive Care Unit: A Multicenter Survey
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Central Line–Associated Bloodstream Infection Surveillance outside the Intensive Care Unit: A Multicenter Survey
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *