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Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

Published online by Cambridge University Press:  24 July 2019

Jesse Couk Open the ORCID record for Jesse Couk [Opens in a new window] ,
Sheri Chernetsky Tejedor ,
James P. Steinberg ,
Chad Robichaux  and
Jesse T. Jacob Open the ORCID record for Jesse T. Jacob [Opens in a new window]
Jesse Couk
Affiliation:
Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Present affiliation: Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC
Sheri Chernetsky Tejedor
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
James P. Steinberg
Affiliation:
Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Chad Robichaux
Affiliation:
Emory Healthcare, Atlanta, Georgia
Jesse T. Jacob*
Affiliation:
Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Author for correspondence: Jesse T. Jacob, MD, Orr Building #1018, 550 Peachtree St NE, Atlanta, GA 30308. E-mail: [email protected]
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Abstract

Background:

The current methodology for calculating central-line–associated bloodstream infection (CLABSI) rates, used for pay-for-performance measures, does not account for multiple concurrent central lines.

Objective:

To compare CLABSI rates using standard National Healthcare Safety Network (NHSN) denominators to rates accounting for multiple concurrent central lines.

Design:

Descriptive analysis and retrospective cohort analysis.

Methods:

We identified all adult patients with central lines at 2 academic medical centers over an 18-month period. CLABSI rates were calculated for intensive care units (ICUs) and non-ICUs using the standard NHSN methodology and denominator (a patient could only have 1 central-line day for a given patient day) and a modified denominator (number of central lines in 1 patient in 1 day count as number of line days). We also compared characteristics of patients with and without multiple concurrent central lines.

Results:

Among 18,521 hospital admissions, there were 156,574 central-line days and 239 CLABSIs (ICU, 105; non-ICU, 134). Our modified denominator reduced CLABSI rates by 25% in ICUs (1.95 vs 1.47 per 1,000 line days) and 6% (1.30 vs 1.22 per 1,000 line days) in non-ICUs. Patients with multiple concurrent central lines were more likely to be in an ICU, to have a longer admission, to have a dialysis catheter, and to have a CLABSI.

Conclusions:

Using the number of central lines as the denominator decreased CLABSI rates in ICUs by 25%. The presence of multiple concurrent central lines may be a marker of severity of illness. The risk of CLABSI per lumen of a central line is similar in ICUs compared to wards.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 1019 - 1023
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Dudeck, MA, Weiner, LM, Allen-Bridson, K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control 2013;41:1148–1166.Google ScholarPubMed
Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.CrossRefGoogle ScholarPubMed
Centers for Disease C, Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. Morb Mortal Wkly Rep 2011;60:243–248.Google Scholar
Center for Disease Control and Prevention. Data tables from National and State Healthcare Associated Infections Progress Report, 2016. Atlanta, GA: DC; 2016.Google Scholar
Scott, RD, 2nd. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published 2009. Accessed June 11, 2019.Google Scholar
Talbot, TR, Bratzler, DW, Carrico, RM, et al. Public reporting of health care-associated surveillance data: recommendations from the healthcare infection control practices advisory committee. Ann Intern Med 2013;159:631–635.CrossRefGoogle ScholarPubMed
Operational guidance for acute-care hospitals to report central-line–associated bloodstream infection (CLABSI) data to CDC’s NHSN for the purpose of fulfilling CMS’s hospital inpatient quality reporting (IQR) requirements, 2014. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/CMS/Final-ACH-CLABSI-Guidance-2015.pdf. Published 2015. Accessed August 16, 2015.Google Scholar
Niedner, MF, National Association of Children’s Health, et al. The harder you look, the more you find: catheter-associated bloodstream infection surveillance variability. Am J Infect Control 2010;38:585–595.Google ScholarPubMed
Steinberg, JP, Coffin, SE. Improving the central line-associated bloodstream infection surveillance definition: a work in progress. Infect Control Hosp Epidemiol 2013;34:777–779.CrossRefGoogle ScholarPubMed
Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31:1286–1289.CrossRefGoogle ScholarPubMed
Concannon, C, van Wijngaarden, E, Stevens, V, Dumyati, G. The effect of multiple concurrent central venous catheters on central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2014;35:1140–1146.CrossRefGoogle ScholarPubMed
Aslakson, RA, Romig, M, Galvagno, SM, et al. Effect of accounting for multiple concurrent catheters on central-line–associated bloodstream infection rates: practical data supporting a theoretical concern. Infect Control Hosp Epidemiol 2011;32:121–124.CrossRefGoogle ScholarPubMed
Scheithauer, S, Hafner, H, Schroder, J, et al. Simultaneous placement of multiple central lines increases central-line–associated bloodstream infection rates. Am J Infect Control 2013;41:113–117.CrossRefGoogle ScholarPubMed
Talbot, TR, Johnson, JG, Anders, T, Hayes, RM. Comparison of NHSN-defined central venous catheter day counts with a method that accounts for concurrent catheters. Infect Control Hosp Epidemiol 2015;36:107–109.CrossRefGoogle ScholarPubMed
Tejedor, SC, Garrett, G, Jacob, JT, et al. Electronic documentation of central venous catheter days: validation is essential. Infect Control Hosp Epidemiol 2013;34:900–907.CrossRefGoogle ScholarPubMed
Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute-care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
Device-associated Module BSI. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed June 24, 2015.Google Scholar
See, I, Iwamoto, M, Allen-Bridson, K, Horan, T, Magill, SS, Thompson, ND. Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition. Infect Control Hosp Epidemiol 2013;34:769–776.CrossRefGoogle ScholarPubMed
Teaching hospitals hit hardest by medicare fines for patient safety. National Public Radio website. http://www.npr.org/sections/health-shots/2014/12/19/371862146/teaching-hospitals-hit-hardest-by-medicare-fines-for-patient-safety. Published 2014. Accessed August 15, 2015.Google Scholar
Templeton, A, Schlegel, M, Fleisch, F, et al. Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study. Infection 2008;36:322–327.CrossRefGoogle ScholarPubMed
Zingg, W, Sax, H, Inan, C, et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009;73:41–46.CrossRefGoogle ScholarPubMed
Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 suppl 2:S89–S107.Google ScholarPubMed
Seddon, ME, Hocking, CJ, Bryce, EA, Hillman, J, McCoubrie, V. From ICU to hospital-wide: extending central-line–associated bacteraemia (CLAB) prevention. N Z Med J 2014;127:60–71.Google ScholarPubMed
Tejedor, SC, Tong, D, Stein, J, et al. Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter.” Infect Control Hosp Epidemiol 2012;33:50–57.CrossRefGoogle Scholar
Jackson, SS, Leekha, S, Magder, LS, et al. The effect of adding comorbidities to current centers for disease control and prevention central-line–associated bloodstream infection risk-adjustment methodology. Infect Control Hosp Epidemiol 2017;38:1019–1024.Google ScholarPubMed