Long-Term Rates of Central Line-Associated Bloodstream Infections (CLABSIs) Following a Regional Infection Control Intervention to Eliminate CLABSIs in Intensive Care Units

Background: From 2000 until 2005 the Pittsburgh Regional Health Initiative (PRHI) with the assistance of the Centers for Disease Control and Prevention implemented an intervention to prevent central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs). Previous analysis demonstrated that CLABSI rates at participating facilities fell significantly from April 2001 to March 2005 compared to other hospitals reporting to the National Nosocomial Infections Surveillance System.

Objective: Determine whether pooled mean rates of CLABSIs reported to the National Healthcare Safety Network (NHSN) from ICUs in facilities participating in PRHI remain lower than CLABSI pooled mean rates in other facilities participating in NHSN.

Methods: Twenty-five facilities that participated in PRHI and contributed data on CLABSIs from at least one medical-surgical ICU (MSICU) from January 2006 through December 2008 were included in the analysis. In order to produce a homogenous comparison group, all non-major teaching NHSN facilities, excluding those participating in the initiative, contributing CLABSI data from MSICUs during the same time period were used for as the first comparison group. All non-major teaching NHSN facilities in Pennsylvania, excluding those participating in the initiative, contributing CLABSI data from MSICUs during the same time period were used as a second comparison group. Pooled mean CLABSI rates were calculated by semi-annual period for each group.  Temporal changes in CLABSI rates were assessed using Poisson regression, controlling for central line use.

Results:   Overall, CLABSI rates were lower for most semi-annual periods for facilities that participated in PRHI than for other NHSN facilities and for other NHSN facilities in Pennsylvania (Table). Results of the temporal analysis showed that the semi-annual incidence rate ratio for both PRHI facilities and all non-major teaching NHSN facilities did not change significantly from 2006 through 2008 (PRHI IRR 1.11 95% CI 0.93-1.32 and NHSN IRR 1.01 95% CI 0.98-1.03).

Table: Semi-annual CLABSI Rates and Risk Ratios for MSICUs at Facilities Participating in PRHI CLABSI Initiative, Non-PRHI NHSN Reporting Facilities, and Pennsylvania Non-PRHI NHSN Reporting Facilities, 2006 – 2008

*PRHI facilities compared to NHSN non-PRHI facilities

†PRHI facilities compared to Pennsylvania non-PRHI facilities

Conclusions: The pooled mean rate of CLABSIs reported from hospitals participating in the PRHI collaborative continues to be significantly lower than those from other facilities reporting to NHSN; however, the decline in CLABSIs in these former collaborative facilities appears to have stabilized. More investigation is required to determine the reasons for the difference in CLABSI rates.