The Impact of Hospital Practice on Central Venous Catheter—Associated Bloodstream Infection Rates at the Patient and Unit Level: A Multicenter Study
- 1 January 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in American Journal of Medical Quality
- Vol. 23 (1), 24-38
- https://doi.org/10.1177/1062860607310918
Abstract
Objective : Little is known about factors driving variation in bloodstream infection (BSI) rates between institutions. The objectives of this study are to (1) identify patient, process of care, and hospital factors that influence intensive care unit (ICU)-level BSI rates and (2) compare those factors to individual risk factors identified in a cohort analysis. Design: In this multicenter prospective observational study, the authors measured the process of care for 2970 randomly sampled central venous catheter insertions over 13 months. Setting: Medical, surgical, and medical/surgical ICUs of 37 domestic and 13 international hospitals. Results: Significant correlates of unit-level BSI rates were percentage of female patients, patients on dialysis, ICU bed size, percentage of practitioners with low numbers of previous insertions, and percentage inserted by nurses. Patient-level analysis identified gender, age, posttransplant, postsurgery, and use of the line for parenteral nutrition. Conclusions: Factors that influence unit-to-unit variation may differ from factors identified in studies of individual patient risk. (Am J Med Qual 2008;23:24-38)Keywords
This publication has 24 references indexed in Scilit:
- Public Disclosure of Healthcare-Associated Infections: The Role of the Society for Healthcare Epidemiology of AmericaInfection Control & Hospital Epidemiology, 2005
- National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004American Journal of Infection Control, 2004
- Prospective surveillance study for risk factors of central venous catheter–related bloodstream infectionsAmerican Journal of Infection Control, 2004
- Preventing Central Venous Catheter-Associated Primary Bloodstream Infections: Characteristics of Practices Among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) StudyInfection Control & Hospital Epidemiology, 2003
- Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care UnitsInfection Control & Hospital Epidemiology, 2003
- A Review of Risk Factors for Catheter-Related Bloodstream Infection Caused by Percutaneously Inserted, Noncuffed Central Venous CathetersMedicine, 2002
- Understanding articles comparing outcomes among intensive care units to rate quality of careCritical Care Medicine, 1998
- Peripherally Inserted Central Catheters: A Report of 2506 Catheter DaysJournal of Parenteral and Enteral Nutrition, 1995
- Using risk-adjusted outcomes to assess clinical practice: An overview of issues pertaining to risk adjustmentThe Annals of Thoracic Surgery, 1994
- National nosocomial infections surveillance system (NNIS): Description of surveillance methodsAmerican Journal of Infection Control, 1991