Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-19T23:46:32.240Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of Accounting for Multiple Concurrent Catheters on Central Line–Associated Bloodstream Infection Rates: Practical Data Supporting a Theoretical Concern

Published online by Cambridge University Press:  02 January 2015

Rebecca A. Aslakson ,
Mark Romig ,
Samuel M. Galvagno Jr ,
Elizabeth Colantuoni ,
Sara E. Cosgrove ,
Trish M. Perl  and
Peter J. Pronovost
Rebecca A. Aslakson*
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Mark Romig
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Samuel M. Galvagno Jr
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Elizabeth Colantuoni
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
Trish M. Perl
Affiliation:
Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
*
The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 297A, Baltimore, MD, 21287-7294 (raslaksl@jhmi.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Central line-associated bloodstream infection (CLABSI) rates are gaining importance as they become publicly reported metrics and potential pay-for-performance indicators. However, the current conventional method by which they are calculated may be misleading and unfairly penalize high-acuity care settings, where patients often have multiple consurrent central venous catheters (CVCs).

Objective.

We compared the conventional method of calculating CLABSI rates, in which the number of catheter-days is used (1 patient with n catheters for 1 day has 1 catheter-day), with a new method that accounts for multiple concurrent catheters (1 patient with n catheters for 1 day has n catheter-days), to determine whether the difference appreciably changes the estimated CLABSI rate.

Design.

Cross-sectional survey.

Setting.

Academic, tertiary care hospital.

Patients.

Adult patients who were consecutively admitted from June 10 through July 9, 2009, to a cardiac-surgical intensive care unit and a surgical intensive and surgical intermediate care unit.

Results.

Using the conventional method, we counted 485 catheter-days throughout the study period, with a daily mean of 18.6 catheter-days (95% confidence interval, 17.2-20.0 catheter-days) in the 2 intensive care units. In contrast, the new method identified 745 catheter-days, with a daily mean of 27.5 catheter-days (95% confidence interval, 25.6-30.3) in the 2 intensive care units. The difference was statistically significant (P < .001). The new method that accounted for multiple concurrent CVCs resulted in a 53.6% increase in the number of catheter-days; this increased denominator decreases the calculated CLABSI rate by 36%.

Conclusions.

The undercounting of catheter-days for patients with multiple concurrent CVCs that occurs when the conventional method of calculating CLABSI rates is used inflates the CLABSI rate for care settings that have a high CVC burden and may not adjust for underlying medical illness. Additional research is needed to validate and generalize our findings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 121 - 124
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infections in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81(9):1159–1171.Google Scholar
2. Wong, ES, Rupp, ME, Mermel, L, et al. Public disclosure of healthcare-associated infections: the role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2005;26:210–212.Google Scholar
3. McKibben, L, Horan, T, Tokars, JI, et al; Healthcare Infection Control Practices Advisory Committee. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Am J Infect Control 2005;33:217–226.Google Scholar
4. Centers for Medicare and Medicaid Services. 2009 Physician Quality Reporting Initiative measure–applicability validation process for claims-based reporting of individual meaures [sic]. Department of Health and Human Services, http://www.cms.hhs.gov. Accessed April 21, 2010.Google Scholar
5. American Medical Association. Physician Consortium for Performance Improvement performance measure status report, last updated January 2010. http://www.ama-assn.org. Accessed April 21, 2010.Google Scholar
6. Dezfulian, C, Lavelle, J, Nallamothu, BK, Kaufman, SR, Saint, S. Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis. Crit Care Med 2003;31:2385–2390.Google Scholar
7. Rosenthal, VD, Maki, DG, Jamulitrat, S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38(2):95–104.Google Scholar
8. Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:62–67.Google Scholar
9. Templton, A, Schlegel, M, Fleisch, F, et al. Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study. Infection 2008;36(4):322–327.Google Scholar
10. Pawar, M, Mehta, Y, Kapoor, P, Sharma, J, Gupta, A, Trehan, N. Central venous catheter-related blood stream infections: incidence, risk factors, outcome, and associated pathogens. J Card-iothorac Vase Anesth 2004;18:304–308.Google Scholar
11. Zürcher, M, Tramèr, MR, Walder, B. Colonization and bloodstream infection with single- versus multilumen central venous catheters: a quantitative systematic review. Anesth Analg 2004;99:177–182.Google Scholar
12. Lucet, JC, Bouadma, L, Zahar, JR, et al. Infectious risks associated with arterial catheters compared with central venous catheters. Crit Care Med 2010;38(4):1030–1035.Google Scholar
13. Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Department of Health and Human Services, http://www.cms.hhs.gov. Accessed August 3, 2010.Google Scholar