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On the Role of Length of Stay in Healthcare-Associated Bloodstream Infection

Published online by Cambridge University Press:  02 January 2015

Christie Y. Jeon ,
Matthew Neidell ,
Haomiao Jia ,
Matt Sinisi  and
Elaine Larson
Christie Y. Jeon*
Affiliation:
Columbia University School of Nursing, New York, New York Center for Cancer Prevention and Control Research, School of Public Health, University of California, Los Angeles, California
Matthew Neidell
Affiliation:
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
Haomiao Jia
Affiliation:
Columbia University School of Nursing, New York, New York
Matt Sinisi
Affiliation:
Columbia University School of Nursing, New York, New York
Elaine Larson
Affiliation:
Columbia University School of Nursing, New York, New York
*
650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095 ([email protected])
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Abstract

Design.

We conducted a retrospective cohort study to examine the role played by length of hospital stay in the risk of healthcare-associated bloodstream infection (BSI), independent of demographic and clinical risk factors for BSI.

Patients.

We employed data from 113,893 admissions from inpatients discharged between 2006 and 2008.

Setting.

Large tertiary healthcare center in New York City.

Methods.

We estimated the crude and adjusted hazard of BSI by conducting logistic regression using a person-day data structure. The covariates included in the fully adjusted model included age, sex, Charlson score of comorbidity, renal failure, and malignancy as static variables and central venous catheterization, mechanical ventilation, and intensive care unit stay as time-varying variables.

Results.

In the crude model, we observed a nonlinear increasing hazard of BSI with increasing hospital stay. This trend was reduced to a constant hazard when fully adjusted for demographic and clinical risk factors for BSI.

Conclusion.

The association between longer length of hospital stay and increased risk of infection can largely be explained by the increased duration of stay among those who have underlying morbidity and require invasive procedures. We should take caution in attributing the association between length of stay and BSI to a direct negative impact of the healthcare environment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 12 , December 2012 , pp. 1213 - 1218
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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