Division of Infectious Diseases Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
Division of Hospital Medicine, Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
Infect Control Hosp Epidemiol. 2019 Sep;40(9):1019-1023. doi: 10.1017/ice.2019.180. Epub 2019 Jul 24.
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.
To compare CLABSI rates using standard National Healthcare Safety Network (NHSN) denominators to rates accounting for multiple concurrent central lines.
Descriptive analysis and retrospective cohort analysis.
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.
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.
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.
目前用于绩效付费措施的中心静脉导管相关性血流感染（CLABSI）率计算方法没有考虑多个同时存在的中心静脉导管。
比较使用标准国家医疗保健安全网络（NHSN）分母和考虑多个同时存在的中心静脉导管的 CLABSI 率。
描述性分析和回顾性队列分析。
我们在 2 所学术医疗中心确定了 18 个月内所有存在中心静脉导管的成年患者。使用 NHSN 标准方法和分母（患者在给定的患者日只能有 1 个中心静脉导管日）以及修改后的分母（1 天内 1 名患者的中心静脉导管数计为导管日数）计算 ICU 和非 ICU 的 CLABSI 率。我们还比较了同时存在多个中心静脉导管的患者和没有同时存在多个中心静脉导管的患者的特征。
在 18521 例住院患者中，有 156574 个中心静脉导管日和 239 例 CLABSI（ICU，105 例；非 ICU，134 例）。我们的修改后的分母使 ICU 的 CLABSI 率降低了 25%（每 1000 个导管日为 1.95 比 1.47），非 ICU 降低了 6%（每 1000 个导管日为 1.30 比 1.22）。同时存在多个中心静脉导管的患者更有可能在 ICU，住院时间更长，有透析导管，并且有 CLABSI。
使用中心静脉导管数作为分母使 ICU 的 CLABSI 率降低了 25%。多个同时存在的中心静脉导管可能是疾病严重程度的标志。与病房相比，ICU 中每个中心静脉导管管腔的 CLABSI 风险相似。
