Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T19:07:52.256Z Has data issue: false hasContentIssue false
  • English
  • Français

Administrative Databases Provide Inaccurate Data for Surveillance of Long-Term Central Venous Catheter-Associated Infections

Published online by Cambridge University Press:  02 January 2015

Sharon B. Wright ,
W. Charles Huskins ,
Rachel S. Dokholyan ,
Donald A. Goldmann  and
Richard Platt
Sharon B. Wright*
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
W. Charles Huskins
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Rachel S. Dokholyan
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Duke Clinical Research Institute, Duke University, Durham, North Carolina
Donald A. Goldmann
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Division of Infectious Diseases, Children's Hospital, Boston, Massachusetts
Richard Platt
Affiliation:
Centers for Disease Control and Prevention Prevention Epicenter of Eastern Massachusetts, Boston, Massachusetts Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Harvard Vanguard Medical Associates, and Harvard Medical School, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
*
Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 330 Brookline Avenue, Mailstop SL-435, Boston, MA 02215
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Efficient methods are needed to monitor infections associated with long-term central venous catheters (CVCs) in both inpatient and outpatient settings. Automated medical records and claims data have been used for surveillance of these infections without evaluation of their accuracy or validity.

Objective:

To determine the feasibility of using electronic records to identify CVC placement and design a system for identifying CVC-associated infections.

Design and Setting:

Retrospective cohort study at an HMO and two teaching hospitals in Boston, one adult (hospital A) and one pediatric (hospital B), between January 1991 and December 1997. Tunneled catheters, totally implanted catheters, and hemodialysis catheters were examined. Claims databases of both the HMO and the hospitals were searched for 10 CPT codes, 2 ICD-9 codes, and internal charge codes indicating CVC insertion. Lists were compared with each other and with medical records for correlation and accuracy.

Patients:

All members of the HMO who had a CVC inserted at one of the two hospitals during the study period.

Results:

There was wide variation in the CVC insertions identified in each database. Although ICD-9 codes at each hospital and CPT/ICD-9 combinations at the HMO found similar total numbers of CVCs, there was little overlap between the individuals identified (62% for hospital A with HMO and 4% for hospital B).

Conclusion:

Claims data from different sources do not identify the same CVC insertion procedures. Current administrative databases are not ready to be used for electronic surveillance of CVC-associated complications without extensive modification and validation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 946 - 949
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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. Graham, DR, Keldermans, MM, Klemm, LW, Semenza, NJ, Shafer, ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med 1991;91(suppl 3B):95S–100S.10.1016/0002-9343(91)90351-WGoogle Scholar
2. Hoch, JR. Management of the complications of long-term venous access. Semin Vase Surg 1997;10:135–143.Google Scholar
3. Adal, KA, Farr, BM. Central venous catheter-related infections: a review. Nutrition 1996;12:208–213.10.1016/S0899-9007(96)91126-0Google Scholar
4. White, MC, Ragland, KE. Surveillance of intravenous catheter-related infections in home care clients. Am J Infect Control 1994;22:231–235.10.1016/0196-6553(94)99002-6Google Scholar
5. Danzig, LE, Short, LJ, Collins, K, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995;273:1862–1864.10.1001/jama.1995.03520470070034Google Scholar
6. Kellerman, S, Shay, DK, Howard, J, et al. Bloodstream infections in home infusion patients: the influence of race and needleless intravascular devices. J Pediatr 1996;129:711–717.10.1016/S0022-3476(96)70154-3Google Scholar
7. Mirro, J Jr, Rao, BN, Stokes, DC, et al. A prospective study of Hickman/Broviac catheters and implantable ports in pediatric oncology patients. J Clin Oncol 1989;7:214–222.10.1200/JCO.1989.7.2.214Google Scholar
8. Tokars, JI, Cookson, ST, McArthur, MA Boyer, CK, McGeer, AJ, Jarvis, WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med 1999;131:340–347.10.7326/0003-4819-131-5-199909070-00004Google Scholar
9. Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963–970.10.1093/infdis/173.4.963Google Scholar
10. Sands, K, Vineyard, G, Livingston, J, Christiansen, C, Platt, R. Efficient identification of postdischarge surgical site infections: use of automated pharmacy dispensing information, administrative data, and medical record information. J Infect Dis 1999;179:434–441.10.1086/314586Google Scholar
11. Platt, R. Harvard Community Health Plan. In: Strom, BL, ed. Pharmacoepidemiology, 2nd ed. West Sussex, England: John Wiley and Sons; 1994:277–287.Google Scholar
12. Puckett, CD, ed. The Educational Annotation of ICD-9-CM, 4th ed. Reno, NV: Channel Publishing; 1997.Google Scholar
13. Kischner, CG, Davis, SJ, Evans, D, et al., eds. Current Procedural Terminology (CPT), 1999 Standard Edition. Chicago: American Medical Association; 1998.Google Scholar
14. Barnett, GO, Justice, NS, Somand, ME, et al. COSTAR a computer-based medical information system for ambulatory care. Proceedings of the Institute of Electrical and Electronics Engineers, Inc. 1979;67:1226–1237.10.1109/PROC.1979.11438Google Scholar