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A Multicenter Longitudinal Study of Hospital-Onset Bacteremia: Time for a New Quality Outcome Measure?

Published online by Cambridge University Press:  23 October 2015

Clare Rock*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
Kerri A. Thom
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Shanahan Li
Affiliation:
Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana
Daniel Morgan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Aaron M. Milstone
Affiliation:
Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Brian Caffo
Affiliation:
Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Manjari Joshi
Affiliation:
Division of Infectious Diseases, University of Maryland Medical Center, School of Medicine, Baltimore, Maryland
Surbhi Leekha
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Address correspondence to Clare Rock, MD, MS, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, 600 North Wolfe Street/Osler 425 Baltimore, MD 21287-5425 (Clare.Rock@jhmi.edu).

Abstract

BACKGROUND

Central-line–associated bloodstream infection (CLABSI) rate is an important quality measure, but it suffers from subjectivity and interrater variability, and decreasing national CLABSI rates may compromise its power to discriminate between hospitals. This study evaluates hospital-onset bacteremia (HOB, ie, any positive blood culture obtained 48 hours post admission) as a healthcare-associated infection–related outcome measure by assessing the association between HOB and CLABSI rates and comparing the power of each to discriminate quality among intensive care units (ICUs).

METHODS

In this multicenter study, ICUs provided monthly CLABSI and HOB rates for 2012 and 2013. A Poisson regression model was used to assess the association between these 2 rates. We compared the power of each measure to discriminate between ICUs using standardized infection ratios (SIRs) with 95% confidence intervals (CIs). A measure was defined as having greater power to discriminate if more of the SIRs (with surrounding CIs) were different from 1.

RESULTS

In 80 ICUs from 16 hospitals in the United States and Canada, a total of 663 CLABSIs, 475,420 central line days, 11,280 HOBs, and 966,757 patient days were reported. An absolute change in HOB of 1 per 1,000 patient days was associated with a 2.5% change in CLABSI rate (P<.001). Among the 80 ICUs, 20 (25%) had a CLABSI SIR and 60 (75%) had an HOB SIR that was different from 1 (P<.001).

CONCLUSION

Change in HOB rate is strongly associated with change in CLABSI rate and has greater power to discriminate between ICU performances. Consideration should be given to using HOB to replace CLABSI as an outcome measure in infection prevention quality assessments.

Infect. Control Hosp. Epidemiol. 2016;37(2):143–148

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Author’s name has been corrected since original publication. An erratum notice detailing this change was also published (DOI 10.1017/ice.2015.314).

References

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