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Background: The NHSN methods for central-line–associated bloodstream infection (CLABSI) surveillance do not account for additive CLABSI risk of concurrent central lines. Past studies were small and modestly risk adjusted but quantified the risk to be ~2-fold. If the attributable risk is this high, facilities that serve high-acuity patients with medically indicated concurrent central-line use may disproportionally incur CMS payment penalties for having high CLABSI rates. We aimed to build evidence through analysis using improved risk adjustment of a multihospital CLABSI experience to influence NHSN CLABSI protocols to account for risks attributed to concurrent central lines. Methods: In a retrospective cohort of adult patients at 4 hospitals (range, 110–733 beds) from 2012 to 2017, we linked central-line data to patient encounter data (age, comorbidities, total parenteral nutrition, chemotherapy, CLABSI). Analysis was limited to patients with >2 central-line days, with either a single central line or concurrence of no more than 2 central lines where insertion and removal dates overlapped by >1 day. Propensity-score matching for likelihood of concurrence and conditional logistic regression modeling estimated the risk of CLABSI attributed to concurrence of >1 day. To evaluate in Cox proportional hazards regression of time to CLABSIs, we also analyzed patients as unique central-line episodes: low risk (ie, ports, dialysis central lines, or PICC) or high risk (ie, temporary or nontunneled) and single versus concurrent. Results: In total, 64,575 central lines were used in 50,254 encounters. Among these patients, 517 developed a CLABSI; 438 (85%) with a single central line and 74 (15%) with concurrence. Moreover, 4,657 (9%) patients had concurrence (range, 6%–14% by hospital); of these, 74 (2%) had CLABSI, compared to 71 of 7,864 propensity-matched controls (1%). Concurrence patients had a median of 17 NHSN central-line days and 21 total central-line days. In multivariate modeling, patients with more concurrence (>2 of 3 of concurrent central-line days) had an higher risk for CLABSI (adjusted risk ratio, 1.62; 95% CI, 1.1–2.3) compared to controls. In survival analysis, 14,610 concurrent central-line episodes were compared to 31,126 single low-risk central-line episodes; adjusting for comorbidity, total parenteral nutrition, and chemotherapy, the daily excess risk of CLABSI attributable to the concurrent central line was ~80% (hazard ratio 1.78 for 2 high-risk or 2 low-risk central lines; hazard ratio 1.80 for a mix of high- and low-risk central lines) (Fig. 1). Notably, the hazard ratio attributed to a single high-risk line compared to a low-risk line was 1.44 (95% CI, 1.13–1.84). Conclusions: Since a concurrent central line nearly doubles the risk for CLABSI compared to a single low-risk line, the CDC should modify NHSN methodology to better account for this risk.
Disclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.
We report on mode-locked thulium-doped fiber lasers with high-energy nanosecond pulses, relying on the transmission in a semiconductor saturable absorber (SESA) and a carbon nanotube (CNTs-PVA) film separately. A section of an SMF–MMF–SMF structure multimode interferometer with a transmission peak wavelength of ∼2003 nm was used as a wavelength selector to fix the laser wavelength. When the SESA acted as a saturable absorber (SA), the mode-locked fiber laser had a maximum output power of ∼461 mW with a pulse energy of ∼0.14 μJ and a pulse duration of ∼9.14 ns. In a CNT-film-based mode-locked fiber laser, stable mode-locked pulses with the maximum output power of ∼46 mW, pulse energy of ∼26.8 nJ and pulse duration of ∼9.3 ns were obtained. To the best of our knowledge, our experiments demonstrated the first 2 μm region ‘real’ SA-based dissipative soliton resonance with the highest mode-locked pulse energy from a ‘real’ SA-based all-fiberized resonator.
Dialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear.
The impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated.
Data from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations.
The rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P < .001), and medical non-renal related, 1.04 (95% CI, 0.89-1.20; P = .63). The estimated number of excess renal-related hospital admissions attributable to Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics.
Hospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.
Howard D, Zhang R, Huang Y, Kutner N. Hospitalization rates among dialysis patients during Hurricane Katrina. Prehosp Disaster Med. 2012;27(4):1-5.
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