Counting Central Line-Associated Infections in the ICU
Counting Central Line-Associated Infections in the ICU
Hi. This is Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Disease Expert Advisor. About a month ago, we talked about the issue associated with calculating central line-associated bloodstream infections and the importance of using the correct denominator. At that time, we discussed the fact that the current Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network methodology is to count each patient whether they have 1, 2, 3, 5, or 10 catheters and single, double, triple, or 20 lumens all as 1 catheter day. At that time, we suggested that another way to do it that might be more accurate (particularly for a large teaching hospital with severely ill patients) is to use the actualnumber of catheters in calculating catheter days.
Well, this month in Infection Control and Hospital Epidemiology, Aslakson and colleagues from Johns Hopkins University published a study that confirms this hypothesis. This study was done in their adult intensive care unit (ICU), cardiac surgery and surgical ICUs, and surgical intermediate care units between June 9 and July 9, 2009. They compared the conventional methodology (1 patient no matter how many lumens or catheters is 1 catheter day) with what they call the "new methodology," which was the actual number of catheter days depending upon the number of catheters that each patient had. The conventional methodology identified 485 catheter days, whereas the new methodology (not counting arterial or peripherally inserted central catheters) identified 745 catheter days. So, the daily mean with the conventional method was 18.6, whereas the daily mean number of catheter days with the new method was 27.5. This was a 53.6% increase in the number of catheter days and when they used this to calculate the bloodstream infection rate, they found with the new methodology a 36% reduction in their central line-associated bloodstream infection rate.
They then conducted an analysis that included arterial lines and found that the number of conventional catheter days was 557 but the number of catheter days using the new methodology was 1293. The daily mean number of catheter days with the conventional method was 22.2 whereas the daily mean with the new methodology was 49. So, there was a 132% increase in catheter days. When they combined all catheters (all central lines, arterial lines, and peripherally inserted central catheters), the number of catheter days by conventional methodology was 578 vs 1293 catheter days with the new methodology. This was a 123% increase in number of catheter days.
This study confirms that we should be calculating the denominator for bloodstream infection rate using all central catheter days, not counting each patient as only 1 catheter day. This is particularly important now when all hospitals are required to report their ICU central line-associated bloodstream infection rates through the CDC's National Healthcare Safety Network to CMS, (Centers for Medicare and Medicaid Services), which will then use these data in 2013 to determine the level of reimbursement. If we are going to link surveillance data to reimbursement, then we must adequately adjust risk so that all hospitals are treated equally.
Until next time, this is Dr. William Jarvis. Thank you very much.
Hi. This is Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Disease Expert Advisor. About a month ago, we talked about the issue associated with calculating central line-associated bloodstream infections and the importance of using the correct denominator. At that time, we discussed the fact that the current Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network methodology is to count each patient whether they have 1, 2, 3, 5, or 10 catheters and single, double, triple, or 20 lumens all as 1 catheter day. At that time, we suggested that another way to do it that might be more accurate (particularly for a large teaching hospital with severely ill patients) is to use the actualnumber of catheters in calculating catheter days.
Well, this month in Infection Control and Hospital Epidemiology, Aslakson and colleagues from Johns Hopkins University published a study that confirms this hypothesis. This study was done in their adult intensive care unit (ICU), cardiac surgery and surgical ICUs, and surgical intermediate care units between June 9 and July 9, 2009. They compared the conventional methodology (1 patient no matter how many lumens or catheters is 1 catheter day) with what they call the "new methodology," which was the actual number of catheter days depending upon the number of catheters that each patient had. The conventional methodology identified 485 catheter days, whereas the new methodology (not counting arterial or peripherally inserted central catheters) identified 745 catheter days. So, the daily mean with the conventional method was 18.6, whereas the daily mean number of catheter days with the new method was 27.5. This was a 53.6% increase in the number of catheter days and when they used this to calculate the bloodstream infection rate, they found with the new methodology a 36% reduction in their central line-associated bloodstream infection rate.
They then conducted an analysis that included arterial lines and found that the number of conventional catheter days was 557 but the number of catheter days using the new methodology was 1293. The daily mean number of catheter days with the conventional method was 22.2 whereas the daily mean with the new methodology was 49. So, there was a 132% increase in catheter days. When they combined all catheters (all central lines, arterial lines, and peripherally inserted central catheters), the number of catheter days by conventional methodology was 578 vs 1293 catheter days with the new methodology. This was a 123% increase in number of catheter days.
This study confirms that we should be calculating the denominator for bloodstream infection rate using all central catheter days, not counting each patient as only 1 catheter day. This is particularly important now when all hospitals are required to report their ICU central line-associated bloodstream infection rates through the CDC's National Healthcare Safety Network to CMS, (Centers for Medicare and Medicaid Services), which will then use these data in 2013 to determine the level of reimbursement. If we are going to link surveillance data to reimbursement, then we must adequately adjust risk so that all hospitals are treated equally.
Until next time, this is Dr. William Jarvis. Thank you very much.
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