Duane Therèse M, Ramanathan Rajesh, Leavell Patricia, Mays Catherine, Ober Janis
1 John Peter Smith Health System , Ft. Worth, Texas.
2 Virginia Commonwealth University Medical Center , Richmond, Virginia.
Surg Infect (Larchmt). 2016 Feb;17(1):13-6. doi: 10.1089/sur.2014.084. Epub 2015 Dec 29.
The incidences of hospital-acquired conditions, such as catheter-associated urinary tract infections (CAUTIs) and central line-associated blood stream infections (CLABSIs) are being used to compare quality at institutions and determine reimbursements. These data come from the University HealthSystem Consortium (UHC) administrative database that relies almost exclusively on physician documentation as opposed to objective U.S. Centers for Disease Control and Prevention (CDC) guidelines. We hypothesize that the UHC-identified rates of CAUTIs and CLABSIs are inaccurate compared with the CDC definitions for these infections.
We performed a retrospective study from January 2012 through September 2013 comparing the incidences of CLABSIs and CAUTIs, as identified through our UHC database to those identified by the Department of Epidemiology using strict CDC guidelines. We performed subset analysis on those infections identified by UHC but not CDC to determine the causes for these discrepancies.
There were a total of 221 CAUTIs and 238 CLABSIs identified during this time frame. Of these, 16 CAUTIs (7.2%) and 44 (18.5%) CLABSIs were detected by both UHC and CDC. 72.4% (42/58) of the CAUTIs and 52.7% (49/93) of the CLABSIs identified by UHC were not identified by CDC. 91% (163/179) of the CAUTIs and 77% (145/189) of the CLABSIs identified by CDC were not identified by UHC. The cause of these differences in identification included lack of culture data, lack of positive cultures, and catheters present on admission.
There is a major disconnect between identification of infections depending on what process is used. This can lead to inappropriate treatment and inaccurate institutional comparisons that impact reimbursements. Because UHC identification of infections are primarily based on physician documentation, educating providers should result in more accurate recognition of infections thereby ensuring appropriate use of therapy.
医院获得性疾病的发生率，如导管相关尿路感染（CAUTI）和中心静脉导管相关血流感染（CLABSI），正被用于比较各机构的医疗质量并确定报销额度。这些数据来自大学卫生系统联盟（UHC）的行政数据库，该数据库几乎完全依赖医生的记录，而非美国疾病控制与预防中心（CDC）的客观指南。我们推测，与CDC对这些感染的定义相比，UHC确定的CAUTI和CLABSI发生率不准确。
我们进行了一项回顾性研究，时间跨度为2012年1月至2013年9月，比较通过UHC数据库确定的CLABSI和CAUTI发生率与流行病学部门依据严格的CDC指南确定的发生率。我们对那些由UHC而非CDC确定的感染进行了亚组分析，以确定这些差异的原因。
在此期间共确定了221例CAUTI和238例CLABSI。其中，UHC和CDC均检测到16例CAUTI（7.2%）和44例（18.5%）CLABSI。UHC确定的CAUTI中有72.4%（42/58）未被CDC检测到，UHC确定的CLABSI中有52.7%（49/93）未被CDC检测到。CDC确定的CAUTI中有91%（163/179）未被UHC检测到，CDC确定的CLABSI中有77%（145/189）未被UHC检测到。这些识别差异的原因包括缺乏培养数据、培养结果为阴性以及入院时存在导管。
根据所采用的流程，感染的识别存在重大脱节。这可能导致不恰当的治疗以及不准确的机构间比较，进而影响报销。由于UHC对感染的识别主要基于医生的记录，对医疗服务提供者进行教育应能使感染得到更准确的识别，从而确保治疗的合理使用。
