Trends in central-line-associated bloodstream infections and catheter-associated urinary tract infections in a large acute-care hospital system in New York City, 2016-2019

Abstract

Background: Central-line bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) negatively impact clinical outcomes and hospital reimbursement. In this report, 4 year trends involving 11 hospitals in New York City were examined. Methods: Data from the National Healthcare Safety Network (NHSN) were extracted for 11 acute-care hospitals belonging to the NYC Health + Hospital system from 2016 through 2019. Trends in device infections per 1,000 patient days, device utilization ratios, and standardized infection ratios (SIRs) were examined for the 11 hospitals and for the entire system. Results: Over the 4-year period, there were progressive declines in central-line days, infections per 1,000 central-line days, and device utilization ratios for the system. The average annual SIRs for the system also declined: 1.40 in 2016, 1.09 in 2017, 1.04 in 2018, and 0.82 in 2019. Case-mix indices correlated with SIRs for CLABSIs. Level 1 trauma centers had higher SIRs and a disproportionately greater number of CLABSIs in patients located in NHSN-defined surgical intensive care units. Similar trends with CAUTIs were noted, with progressive declines in catheter days, infections per 1,000 patient days, device utilization ratios, and SIRs (1.42 in 2016, 0.93 in 2017, 1.18 in 2018, and 0.78 in 2019) over the 4-year period. Conclusions: Across an 11-hospital system, continuing efforts to reduce device utilization and infection rates resulted in declining SIRs for CLABSIs and CAUTIs. Hospitals with higher case-mix indices, and particularly level 1 trauma centers, had significantly higher central-line infection rates and SIRs.

Prevalence of Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care and Medical-Surgical Units

“…Our institution’s poor CLIP form compliance was suggested to be due to the high volume of trauma cases and the emergent conditions under which CVCs are placed to resuscitate and stabilize trauma patients. Major trauma centers have been found to have higher rates of CLABSI [ 11 ]. In such cases, although adherence to best insertion practices may be difficult it must be required.…”

Incidencia de infecciones asociadas a dispositivos en unidades de cuidados intensivos adulto y pediátrica. Colombia, 2012-2021

“…Entre otras, la explicación de esta reducción está en las capacitaciones realizadas al personal sobre el control de infecciones, reforzar las precauciones frente al aislamiento de pacientes, así como, del uso de elementos de protección personal y de las técnicas de higiene de manos (23) . En Estados Unidos, hubo disminuciones progresivas, en el periodo 2016-2019, explicando, entre otras, por la reducción de los días de utilización de dispositivos en los pacientes (24) . Finalmente, una investigación realizada en Holanda estableció que las tasas de ITS AC y NAV entre pacientes hospitalizados aumentaron durante el primer año de la pandemia, observándose tasas más altas de ITS AC en la población de UCI con y sin COVID-19 (25) .…”

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

“…Daily assessment of invasive devices for continued need and early detection of complications enhances patient safety. Implementation studies of multimodal bundles, including daily prompts of device necessity, have achieved reduction in utilization of IUCs (Gazarin et al, 2020;Giles et al, 2020;Kuriyama et al, 2019;Niederhauser et al, 2019;Schweiger et al, 2020), CVADs (Kara et al, 2016;Kleinman Sween et al, 2021;Walz et al, 2015;Xiong & Chen, 2018), CVADs and IUCs (Chandramohan et al, 2018;Kaminski et al, 2021;Mena Lora et al, 2020), IUCs and PIVCs (Laan et al, 2020), andPIVCs (Egerton-Warburton et al, 2019;Mestre et al, 2013;Yagnik et al, 2017). Interventions that employ education, daily reminders, and automated stop-orders demonstrate greater clinician awareness of device use and prompt removal of unnecessary devices, with subsequent reductions in complications and infections (Kleinman Sween et al, 2021;Meddings et al, 2020;Mitchell et al, 2019;Yu et al, 2020), but continued vigilance is crucial (Chandramohan et al, 2018).…”