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Impact of multiple concurrent central lines on central-line-associated bloodstream infection rates
Jesse Couk1, Sheri Chernetsky Tejedor2, James P Steinberg1
1Division of Infectious Diseases Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
Insights
Calculating central-line-associated bloodstream infection (CLABSI) rates needs to account for multiple central lines. A modified method reduced ICU CLABSI rates by 25%, suggesting multiple lines may indicate illness severity.
Area of Science:
- Infection control
- Healthcare quality improvement
- Epidemiology
Background:
- Current methods for calculating central-line-associated bloodstream infection (CLABSI) rates do not account for patients with multiple concurrent central lines.
- This impacts pay-for-performance measures in healthcare settings.
Purpose of the Study:
- To compare CLABSI rates using standard National Healthcare Safety Network (NHSN) denominators versus rates that account for multiple concurrent central lines.
- To evaluate the impact of a modified denominator on CLABSI rate calculations.
Main Methods:
- A retrospective cohort analysis of adult patients with central lines at two academic medical centers over 18 months.
- CLABSI rates were calculated using standard NHSN methodology and a modified denominator that counts each central line per patient per day.
- Patient characteristics were compared between those with and without multiple concurrent central lines.
Main Results:
- Among 18,521 admissions, 156,574 central-line days and 239 CLABSIs were recorded.
- The modified denominator reduced CLABSI rates by 25% in ICUs and 6% in non-ICUs.
- Patients with multiple concurrent central lines were more likely to be in the ICU, have longer admissions, and have a dialysis catheter.
Conclusions:
- Adjusting the denominator to count each central line significantly decreases calculated CLABSI rates, particularly in ICUs.
- The presence of multiple concurrent central lines may serve as an indicator of patient severity of illness.
- The risk of CLABSI per lumen appears consistent across ICU and non-ICU settings.
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.
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