Dataset Information

Surveillance length and validity of benchmarks for central line-associated bloodstream infection incidence rates in intensive care units.

ABSTRACT:

Introduction

Several national and regional central line-associated bloodstream infections (CLABSI) surveillance programs do not require continuous hospital participation. We evaluated the effect of different hospital participation requirements on the validity of annual CLABSI incidence rate benchmarks for intensive care units (ICUs).

Methods

We estimated the annual pooled CLABSI incidence rates for both a real regional (<100 ICUs) and a simulated national (600 ICUs) surveillance program, which were used as a reference for the simulations. We simulated scenarios where the annual surveillance participation was randomly or non-randomly reduced. Each scenario's annual pooled CLABSI incidence rate was estimated and compared to the reference rates in terms of validity, bias, and proportion of simulation iterations that presented valid estimates (ideal if ? 90%).

Results

All random scenarios generated valid CLABSI incidence rates estimates (bias -0.37 to 0.07 CLABSI/1000 CVC-days), while non-random scenarios presented a wide range of valid estimates (0 to 100%) and higher bias (-2.18 to 1.27 CLABSI/1000 CVC-days). In random scenarios, the higher the number of participating ICUs, the shorter the participation required to generate ? 90% valid replicates. While participation requirements in a countrywide program ranged from 3 to 13 surveillance blocks (1 block = 28 days), requirements for a regional program ranged from 9 to 13 blocks.

Conclusions

Based on the results of our model of national CLABSI reporting, the shortening of participation requirements may be suitable for nationwide ICU CLABSI surveillance programs if participation months are randomly chosen. However, our regional models showed that regional programs should opt for continuous participation to avoid biased benchmarks.

SUBMITTER: Fontela PS

PROVIDER: S-EPMC3346722 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Surveillance length and validity of benchmarks for central line-associated bloodstream infection incidence rates in intensive care units.

Fontela Patricia S PS Quach Caroline C Buckeridge David D Pai Madukhar M Platt Robert W RW

PloS one 20120507 5

<h4>Introduction</h4>Several national and regional central line-associated bloodstream infections (CLABSI) surveillance programs do not require continuous hospital participation. We evaluated the effect of different hospital participation requirements on the validity of annual CLABSI incidence rate benchmarks for intensive care units (ICUs).<h4>Methods</h4>We estimated the annual pooled CLABSI incidence rates for both a real regional (<100 ICUs) and a simulated national (600 ICUs) surveillance p ...[more]

PMID: 22586480

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Project description:ObjectivesTo evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients' safety.SettingIntensive care units predominantly in Michigan, USA.InterventionConceptual model aimed at improving clinicians' use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders.Main outcome measuresQuarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention).ResultsNinety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (-1%, 95% confidence interval -9% to 7%).ConclusionsThe reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.

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Dataset Information

Surveillance length and validity of benchmarks for central line-associated bloodstream infection incidence rates in intensive care units.

Introduction

Methods

Results

Conclusions

Publications

Surveillance length and validity of benchmarks for central line-associated bloodstream infection incidence rates in intensive care units.

Similar Datasets

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