Effect of accounting for multiple concurrent catheters on central line-associated bloodstream infection rates: Practical data supporting a theoretical concern

Rebecca A. Aslakson, Mark Romig, Samuel M. Galvagno, Elizabeth Colantuoni, Sara E. Cosgrove, Trish M. Perl, Peter J. Pronovost

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND. Central line-associated bloodstream infection (CLABSI) rates are gaining importance as they become publicly reported metrics and potential pay-for-performance indicators. However, the current conventional method by which they are calculated may be misleading and unfairly penalize high-acuity care settings, where patients often have multiple concurrent central venous catheters (CVCs). OBJECTIVE. We compared the conventional method of calculating CLABSI rates, in which the number of catheter-days is used (1 patient with n catheters for 1 day has 1 catheter-day), with a new method that accounts for multiple concurrent catheters (1 patient with n catheters for 1 day has n catheter-days), to determine whether the difference appreciably changes the estimated CLABSI rate. DESIGN. Cross-sectional survey. SETTING. Academic, tertiary care hospital. PATIENTS. Adult patients who were consecutively admitted from June 10 through July 9, 2009, to a cardiac-surgical intensive care unit and a surgical intensive and surgical intermediate care unit. RESULTS. Using the conventional method, we counted 485 catheter-days throughout the study period, with a daily mean of 18.6 catheterdays (95% confidence interval, 17.2-20.0 catheter-days) in the 2 intensive care units. In contrast, the new method identified 745 catheterdays, with a daily mean of 27.5 catheter-days (95% confidence interval, 25.6-30.3) in the 2 intensive care units. The difference was statistically significant (P<.001). The new method that accounted for multiple concurrent CVCs resulted in a 53.6% increase in the number of catheter-days; this increased denominator decreases the calculated CLABSI rate by 36%. CONCLUSIONS. The undercounting of catheter-days for patients with multiple concurrent CVCs that occurs when the conventional method of calculating CLABSI rates is used inflates the CLABSI rate for care settings that have a high CVC burden and may not adjust for underlying medical illness. Additional research is needed to validate and generalize our findings.

Original languageEnglish (US)
Pages (from-to)121-124
Number of pages4
JournalInfection Control and Hospital Epidemiology
Volume32
Issue number2
DOIs
StatePublished - Feb 1 2011

Fingerprint

Catheters
Infection
Central Venous Catheters
Intensive Care Units
Confidence Intervals
Critical Care
Incentive Reimbursement
Tertiary Healthcare
Tertiary Care Centers
Patient Care
Cross-Sectional Studies
Research

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

Effect of accounting for multiple concurrent catheters on central line-associated bloodstream infection rates : Practical data supporting a theoretical concern. / Aslakson, Rebecca A.; Romig, Mark; Galvagno, Samuel M.; Colantuoni, Elizabeth; Cosgrove, Sara E.; Perl, Trish M.; Pronovost, Peter J.

In: Infection Control and Hospital Epidemiology, Vol. 32, No. 2, 01.02.2011, p. 121-124.

Research output: Contribution to journalArticle

Aslakson, Rebecca A. ; Romig, Mark ; Galvagno, Samuel M. ; Colantuoni, Elizabeth ; Cosgrove, Sara E. ; Perl, Trish M. ; Pronovost, Peter J. / Effect of accounting for multiple concurrent catheters on central line-associated bloodstream infection rates : Practical data supporting a theoretical concern. In: Infection Control and Hospital Epidemiology. 2011 ; Vol. 32, No. 2. pp. 121-124.
@article{cbfaefb833b2401f9ae868b39cb8cae1,
title = "Effect of accounting for multiple concurrent catheters on central line-associated bloodstream infection rates: Practical data supporting a theoretical concern",
abstract = "BACKGROUND. Central line-associated bloodstream infection (CLABSI) rates are gaining importance as they become publicly reported metrics and potential pay-for-performance indicators. However, the current conventional method by which they are calculated may be misleading and unfairly penalize high-acuity care settings, where patients often have multiple concurrent central venous catheters (CVCs). OBJECTIVE. We compared the conventional method of calculating CLABSI rates, in which the number of catheter-days is used (1 patient with n catheters for 1 day has 1 catheter-day), with a new method that accounts for multiple concurrent catheters (1 patient with n catheters for 1 day has n catheter-days), to determine whether the difference appreciably changes the estimated CLABSI rate. DESIGN. Cross-sectional survey. SETTING. Academic, tertiary care hospital. PATIENTS. Adult patients who were consecutively admitted from June 10 through July 9, 2009, to a cardiac-surgical intensive care unit and a surgical intensive and surgical intermediate care unit. RESULTS. Using the conventional method, we counted 485 catheter-days throughout the study period, with a daily mean of 18.6 catheterdays (95{\%} confidence interval, 17.2-20.0 catheter-days) in the 2 intensive care units. In contrast, the new method identified 745 catheterdays, with a daily mean of 27.5 catheter-days (95{\%} confidence interval, 25.6-30.3) in the 2 intensive care units. The difference was statistically significant (P<.001). The new method that accounted for multiple concurrent CVCs resulted in a 53.6{\%} increase in the number of catheter-days; this increased denominator decreases the calculated CLABSI rate by 36{\%}. CONCLUSIONS. The undercounting of catheter-days for patients with multiple concurrent CVCs that occurs when the conventional method of calculating CLABSI rates is used inflates the CLABSI rate for care settings that have a high CVC burden and may not adjust for underlying medical illness. Additional research is needed to validate and generalize our findings.",
author = "Aslakson, {Rebecca A.} and Mark Romig and Galvagno, {Samuel M.} and Elizabeth Colantuoni and Cosgrove, {Sara E.} and Perl, {Trish M.} and Pronovost, {Peter J.}",
year = "2011",
month = "2",
day = "1",
doi = "10.1086/657941",
language = "English (US)",
volume = "32",
pages = "121--124",
journal = "Infection Control and Hospital Epidemiology",
issn = "0899-823X",
publisher = "University of Chicago Press",
number = "2",

}

TY - JOUR

T1 - Effect of accounting for multiple concurrent catheters on central line-associated bloodstream infection rates

T2 - Practical data supporting a theoretical concern

AU - Aslakson, Rebecca A.

AU - Romig, Mark

AU - Galvagno, Samuel M.

AU - Colantuoni, Elizabeth

AU - Cosgrove, Sara E.

AU - Perl, Trish M.

AU - Pronovost, Peter J.

PY - 2011/2/1

Y1 - 2011/2/1

N2 - BACKGROUND. Central line-associated bloodstream infection (CLABSI) rates are gaining importance as they become publicly reported metrics and potential pay-for-performance indicators. However, the current conventional method by which they are calculated may be misleading and unfairly penalize high-acuity care settings, where patients often have multiple concurrent central venous catheters (CVCs). OBJECTIVE. We compared the conventional method of calculating CLABSI rates, in which the number of catheter-days is used (1 patient with n catheters for 1 day has 1 catheter-day), with a new method that accounts for multiple concurrent catheters (1 patient with n catheters for 1 day has n catheter-days), to determine whether the difference appreciably changes the estimated CLABSI rate. DESIGN. Cross-sectional survey. SETTING. Academic, tertiary care hospital. PATIENTS. Adult patients who were consecutively admitted from June 10 through July 9, 2009, to a cardiac-surgical intensive care unit and a surgical intensive and surgical intermediate care unit. RESULTS. Using the conventional method, we counted 485 catheter-days throughout the study period, with a daily mean of 18.6 catheterdays (95% confidence interval, 17.2-20.0 catheter-days) in the 2 intensive care units. In contrast, the new method identified 745 catheterdays, with a daily mean of 27.5 catheter-days (95% confidence interval, 25.6-30.3) in the 2 intensive care units. The difference was statistically significant (P<.001). The new method that accounted for multiple concurrent CVCs resulted in a 53.6% increase in the number of catheter-days; this increased denominator decreases the calculated CLABSI rate by 36%. CONCLUSIONS. The undercounting of catheter-days for patients with multiple concurrent CVCs that occurs when the conventional method of calculating CLABSI rates is used inflates the CLABSI rate for care settings that have a high CVC burden and may not adjust for underlying medical illness. Additional research is needed to validate and generalize our findings.

AB - BACKGROUND. Central line-associated bloodstream infection (CLABSI) rates are gaining importance as they become publicly reported metrics and potential pay-for-performance indicators. However, the current conventional method by which they are calculated may be misleading and unfairly penalize high-acuity care settings, where patients often have multiple concurrent central venous catheters (CVCs). OBJECTIVE. We compared the conventional method of calculating CLABSI rates, in which the number of catheter-days is used (1 patient with n catheters for 1 day has 1 catheter-day), with a new method that accounts for multiple concurrent catheters (1 patient with n catheters for 1 day has n catheter-days), to determine whether the difference appreciably changes the estimated CLABSI rate. DESIGN. Cross-sectional survey. SETTING. Academic, tertiary care hospital. PATIENTS. Adult patients who were consecutively admitted from June 10 through July 9, 2009, to a cardiac-surgical intensive care unit and a surgical intensive and surgical intermediate care unit. RESULTS. Using the conventional method, we counted 485 catheter-days throughout the study period, with a daily mean of 18.6 catheterdays (95% confidence interval, 17.2-20.0 catheter-days) in the 2 intensive care units. In contrast, the new method identified 745 catheterdays, with a daily mean of 27.5 catheter-days (95% confidence interval, 25.6-30.3) in the 2 intensive care units. The difference was statistically significant (P<.001). The new method that accounted for multiple concurrent CVCs resulted in a 53.6% increase in the number of catheter-days; this increased denominator decreases the calculated CLABSI rate by 36%. CONCLUSIONS. The undercounting of catheter-days for patients with multiple concurrent CVCs that occurs when the conventional method of calculating CLABSI rates is used inflates the CLABSI rate for care settings that have a high CVC burden and may not adjust for underlying medical illness. Additional research is needed to validate and generalize our findings.

UR - http://www.scopus.com/inward/record.url?scp=78751652862&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78751652862&partnerID=8YFLogxK

U2 - 10.1086/657941

DO - 10.1086/657941

M3 - Article

C2 - 21460465

AN - SCOPUS:78751652862

VL - 32

SP - 121

EP - 124

JO - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

SN - 0899-823X

IS - 2

ER -