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Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

Published online by Cambridge University Press:  24 July 2019

Jesse Couk Open the ORCID record for Jesse Couk [Opens in a new window] ,
Sheri Chernetsky Tejedor ,
James P. Steinberg ,
Chad Robichaux  and
Jesse T. Jacob Open the ORCID record for Jesse T. Jacob [Opens in a new window]
Jesse Couk
Affiliation:
Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Present affiliation: Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC
Sheri Chernetsky Tejedor
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory Healthcare, Atlanta, Georgia
James P. Steinberg
Affiliation:
Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Chad Robichaux
Affiliation:
Emory Healthcare, Atlanta, Georgia
Jesse T. Jacob*
Affiliation:
Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Author for correspondence: Jesse T. Jacob, MD, Orr Building #1018, 550 Peachtree St NE, Atlanta, GA 30308. E-mail: jtjacob@emory.edu
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Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 1019 - 1023
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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