Comparing Hospital-Onset Bacteremia to Central Line Associated Bloodstream Infection as a Hospital Quality Measure
Abstract
Background Central Line Associated Bloodstream Infections (CLABSI) rates are a benchmark for hospital quality despite problems with surveillance bias and inter-observer variability and subjectivity. The rate of Hospital-onset bacteremia (HOB) may offer significant advantages over CLABSI; including being more objective and un-biased. Methods We conducted a multisite cohort study via the Society for Healthcare Epidemiology of America (SHEA) research network to examine the relationship between HOB and CLABSI rates and compare ability of each to distinguish between hospitals. Hospitals reported total CLABSIs, central line days, HOBs, patient days, and total blood cultures performed for each ICU and completed a survey relating to CLABSI reporting. Mixed-effect Poisson regression was used to evaluate HOB as a predictor for CLABSI. Standardized infection ratios (SIR) for HOB and CLABSI for medical and neonatal ICUs were calculated using the pooled mean rates of the study sample as the benchmark. Results We obtained data for 79 ICUs from 15 hospitals within the US and Canada. From January 2012 to December 2013, 627 CLABSIs, 11 024 HOB, 464 224 central line days and 959 647 ICU patient days were reported. HOB was a strong predictor of CLABSI; a change in the rate of HOB of 1 predicted a relative change of 2.2% in CLABSI rate. Standardized infection ratios for HOB and CLABSI for medical and neonatal ICUs showed large confidence intervals that overlapped with each other for the CLABSI measure with 14 of 18 (77.7%) CLABSI 95% confidence intervals containing the null value of 1, compared to only 6 of 18 (33.3%) HOB 95% confidence intervals (p-value 0.02, fisher's exact test). CLABSI reporting requires 15.8 hours of nurse time per month. Conclusions In this multicenter study, HOB rates were strongly predictive of CLABSI rates. HOB can be collected automatically saving nurse time and provide better discrimination hospital quality than CLABSI.Description
University of Maryland, Baltimore. Epidemiology and Preventive Medicine. M.S. 2014Keyword
central line-associated bloodstream infectionhospital associated infection
hospital-onset bacteremia
outcome measures in healthcare quality
standardized infection ratio
surveillance of healthcare-associated infections
Cross Infection
Outcome Assessment (Health Care)
Identifier to cite or link to this item
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The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infectionsIntra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections. Copyright 2017 The Author(s).
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Infection Rates and Risk Factors for Infection among Health Workers during Ebola and Marburg Virus Outbreaks: A Systematic ReviewInfection in health workers (HWs) has characterized outbreaks of Ebola virus disease (EVD) and Marburg virus disease (MVD). We conducted a systematic review to investigate infection and mortality rates and common exposure risks in HWs in EVD and MVD outbreaks. Methods. We searched the EMBASE and PubMed databases to identify articles posted before 27 December 2017, with no language restrictions. Data on the number, frequency, and mortality of HW infection and exposure risks were extracted. Results. Ninety-four articles related to 22 outbreaks were included. HW infections composed 2%-100% of cases in EVD and 5%-50% of cases in MVD outbreaks. Among exposed HWs, 0.6%-92% developed EVD, and 1%-10% developed MVD. HW infection rates were consistent through outbreaks. The most common exposure risk situations were inadequate personal protective equipment and exposure to patients with unrecognized EVD/MVD. Similar risks were reported in past EVD/MVD outbreaks and in the recent outbreak in West Africa. Conclusions. Many outbreaks reported high proportions of infected HWs. Similar HW infection rates and exposure risk factors in both past and recent EVD and MVD outbreaks emphasize the need to improve the implementation of appropriate infection control measures consistently across all healthcare settings. Copyright 2018. Published by Oxford University Press for the Infectious Diseases Society of America.