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National Estimates of Central Line–Associated Bloodstream Infections in Critical Care Patients

Published online by Cambridge University Press:  02 January 2015

Matthew E. Wise ,
R. Douglas Scott II ,
James M. Baggs ,
Jonathan R. Edwards ,
Katherine D. Ellingson ,
Scott K. Fridkin ,
L. Clifford McDonald  and
John A. Jernigan
Matthew E. Wise*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
R. Douglas Scott II
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
James M. Baggs
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Katherine D. Ellingson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Scott K. Fridkin
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
L. Clifford McDonald
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-38, Atlanta, GA 30333 ([email protected]).
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Abstract

Objective.

Recent studies have demonstrated that central line-associated bloodstream infections (CLABSIs) are preventable through implementation of evidence-based prevention practices. Hospitals have reported CLABSI data to the Centers for Disease Control and Prevention (CDC) since the 1970s, providing an opportunity to characterize the national impact of CLABSIs over time. Our objective was to describe changes in the annual number of CLABSIs in critical care patients in the United States.

Design.

Monte Carlo simulation.

Setting.

US acute care hospitals.

Patients.

Nonneonatal critical care patients.

Methods.

We obtained administrative data on patient-days for nearly all US hospitals and applied CLABSI rates from the National Nosocomial Infections Surveillance and the National Healthcare Safety Network systems to estimate the annual number of CLABSIs in critical care patients nationally during the period 1990–2010 and the number of CLABSIs prevented since 1990.

Results.

We estimated that there were between 462,000 and 636,000 CLABSIs in nonneonatal critical care patients in the United States during 1990–2010. CLABSI rate reductions led to between 104,000 and 198,000 fewer CLABSIs than would have occurred if rates had remained unchanged since 1990. There were 15,000 hospital-onset CLABSIs in nonneonatal critical care patients in 2010; 70% occurred in medium and large teaching hospitals.

Conclusions.

Substantial progress has been made in reducing the occurrence of CLABSIs in US critical care patients over the past 2 decades. The concentration of critical care CLABSIs in medium and large teaching hospitals suggests that a targeted approach may be warranted to continue achieving reductions in critical care CLABSIs nationally.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 6 , June 2013 , pp. 547 - 554
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.National Nosocomial Infections Surveillance system. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32(8):470–485.CrossRefGoogle Scholar
2.Dudeck, MA, Horan, TC, Peterson, KD, et al.National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011;39(5):349–367.Google Scholar
3. Centers for Disease Control and Prevention. First State-Specific Healthcare-Associated Infections Summary Data Report: CDC's National Healthcare Safety Network (NHSN), January–June, 2009. http://www.cdc.gov/hai/pdfs/stateplans/SIR_05_25_2010.pdf. Published 2010. Accessed February 23, 2012.Google Scholar
4.Department of Health and Human Services. Action Plan to Prevent Healthcare-Associated Infections: Incentives and Oversight. http://www.hhs.gov/ash/initiatives/hai/actionplan/hhs_hai_action_plan_fmal_06222009.pdf. Published 2009. Accessed February 23, 2012.Google Scholar
5. National Conference of State Legislatures. Hospital-acquired infection legislation database, http://www.ncsl.org/issues-research/health/hospital-acquired-infection-legislation-database.aspx. Accessed February 23, 2012.Google Scholar
6.Centers for Disease Control and Prevention. Reduction in central line–associated bloodstream infections among patients in intensive care units—Pennsylvania, April 2001–March 2005. MMWR Morb Mortal Wkly Rep 2005;54(40): 1013–1016.Google Scholar
7.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725–2732.Google Scholar
8.Casey, AL, Mermel, LA, Nightingale, P, Elliott, TS. Antimicrobial central venous catheters in adults: a systematic review and meta-analysis. Lancet Infect Dis 2008;8(12):763–776.Google Scholar
9.Timsit, JF, Schwebel, C, Bouadma, L, et al.Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301(12):1231–1241.Google Scholar
10.Warren, DK, Cosgrove, SE, Diekema, DJ, et al.A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 2006;27(7):662–669.Google Scholar
11.Warren, DK, Zack, JE, Cox, MJ, et al.An educational intervention to prevent catheter-associated bloodstream infections in a non-teaching, community medical center. Crit Care Med 2003;31(7): 1959–1963.CrossRefGoogle Scholar
12.Centers for Medicare and Medicaid Services. Cost Reports. http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/CostReports/index.html. Accessed January 6, 2012.Google Scholar
13. Annual survey database. American Hospital Association website. http://www.ahadata.com/ahadata/html/AHASurvey.html. Published 2010. Accessed February 23, 2012.Google Scholar
14.Edwards, JR, Peterson, KD, Andrus, ML, et al.National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36(9):609–626.Google Scholar
15.Shuman, EK, Washer, LL, Arndt, JL, et al.Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol 2010;31(5):551–553.Google Scholar
16.Shapey, IM, Foster, MA, Whitehouse, T, et al.Central venous catheter-related bloodstream infections: improving post-insertion catheter care. J Hosp Infect 2009;71(2):117–122.CrossRefGoogle ScholarPubMed
17.Timsit, JF, Dubois, Y, Minet, C, et al.New materials and devices for preventing catheter-related infections. Ann Intensive Care 2011;1:34.CrossRefGoogle ScholarPubMed
18.Sanders, J, Pithie, A, Ganly, P, et al.A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. J Antimicrob Chemother 2008;62(4):809–815.Google Scholar
19.Centers for Disease Control and Prevention. Vital signs: central line–associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Report 2011;60(8): 243–248.Google Scholar
20.Chan, CK, Feinstein, AR, Jekel, JF, et al.The value and hazards of standardization in clinical epidemiologic research. J Clin Epidemiol 1988;41(11):1125–1134.CrossRefGoogle ScholarPubMed
21.Burton, DC, Edwards, JR, Srinivasan, A, Fridkin, SK, Gould, CV. Trends in catheter-associated urinary tract infections in adult intensive care units—United States, 1990–2007. Infect Control Hosp Epidemiol 2011;32(8):748–756.Google Scholar
22.Magill, S, Edwards, J, Fridkin, S. Ventilator-associated pneumonia in the National Nosocomial Infections Surveillance system and the National Healthcare Safety Network: analysis of incidence and pathogen distribution, 2002–2008. Abstract presented at: 5th Decennial International Conference on Healthcare-Associated Infections, 2010.Google Scholar
23.Anderson, DJ, Miller, BA, Chen, LF, et al.The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32(4):315–322.Google Scholar
24.Dixon-Woods, M, Leslie, M, Bion, J, et al.What counts? an ethnographic study of infection data reported to a patient safety program. Milbank Q 2012;90(3):548–591.Google Scholar