S. Kuy1,2, R. Gupta1, S. Awad1,2 1Baylor College Of Medicine,Surgery,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Surgery,Houston, TX, USA
Introduction: Currently, Central Lines Associated Blood Stream Infection (CLABSI) rates are reported as number of infections per 1,000 catheter days, but this definition has been the subject of controversy as it does not take into account patient characteristics, comorbidities or risks for developing a hospital acquired infection (HAI). By defining CLABSI as a never event, there has been a national push to reduce CLABSI rates with penalties from CMS. Huge efforts have been performed with CLABSI bundles and checklists in order to decrease overall rates with published success.[i] In addition, efforts have been made to remove central line catheters sooner, decreasing the denominator of the CLABSI rate. Given CLABSI is adjusted based on number of catheter days, our objective was to determine the impact of catheter days on CLABSI rate by comparing the rate of decrease in number of CLABSI and the rate of decrease in catheter days.
Methods: A retrospective chart review was performed on surgical patients in a tertiary care academic medical center, from Fiscal Year 2016 to present. Catheter days, number of CLABSI, CLABSI rates, and compliance with CLABSI bundle insertion were collected. Linear regression was performed to determine the rate of decrease in absolute number of infections and compare it to the rate of decrease in catheter days.
Results: During the study period, compliance with CLABSI bundle was 86%. The total number of infections decreased by 58% (2016: 12, 2019: 5). There was a 22.3% decrease in catheter days (2016: 3910, 2019: 3,198). The CLABSI rate decreased by 49%, from 3.06% to 1.56%. Linear regression demonstrated that the rate of decrease in infections was greater than the rate of decrease in catheter days (Graph).
Conclusion: Despite high adherence to CLABSI bundles and use of checklists, CLABSI decreased over time but were not a “never event”. Although our data demonstrates a decrease in the number of CLABSI and catheter days, the observed decrease in CLABSI rates was due to the significantly higher decrease in CLABSI episodes. Current definitions of CLABSI do not take into account the overall severity of patient illness and risk for development of a hospital acquired infection. A risk adjusted CLABSI rate should be developed and used.
Reference:
[i] Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006 Dec 28;355(26):2725-32.
