Device-associated Healthcare Infections at Veterans Affairs Hospitals, 2006-2008

Background: Healthcare-associated infections (HAI) are responsible for increased morbidity and mortality, prolonged hospitalization and excess healthcare cost.  Veterans receiving inpatient care at Department of Veterans Affairs (VA) Medical Centers are at high risk for HAIs due to advanced age and high prevalence of underlying chronic conditions.  Prevention efforts to decrease HAIs among veterans should be data driven, yet a comprehensive surveillance system to assess HAI rates in VA is not available yet.  The National Healthcare Safety Network (NHSN) collects data from a subset of VA hospitals using standardized protocols.  These data currently constitute the only source of aggregate data suitable to estimate pooled HAI rates and device utilization ratios at VA facilities.  To date, no published report has described aggregated HAIs rates from VA facilities on NHSN.

Objective: To describe rates of central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI) and ventilator-associated pneumonias (VAP) from VA hospitals that voluntarily report data to NHSN.

Methods: Selected HAIs reported between January 2006 and December 2008 from cardiac, medical, medical/surgical and surgical intensive care units (ICU) at 28 VA facilities were analyzed. Pooled means rates per 1,000 device days and utilization ratios for CLABSI, CAUTI and VAP were calculated using standard NHSN methods. 
Results:  Median size of 28 VA hospitals included was 162 beds and most are located in Northeast U.S.  There were 48 ICUs that reported at least one month of data during three years of surveillance.  Combined, these ICUs reported 228 CLABSI (913 months of surveillance), 226 CAUTI (432 months) and 230 VAP (807 months). Pooled mean CLABSI rates were highest in medical ICUs (3.5/1,000 lines days) and lowest in medical/surgical ICUs (1.7/1,000 lines days).  The highest pooled CAUTI rates were from medical /surgical and cardiac units (3.8/1,000 catheter days) and lowest in surgical units (2.4/1,000 catheter days). Highest VAP rates were observed in surgical units (4.7/1,000 ventilator days) and lowest in cardiac (2.0/1,000 ventilator days) units.  Central line, urinary catheters and ventilator utilization ratios were consistently higher in surgical and medical surgical units and lowest in medical and medical/surgical regardless of type of HAI.  

Conclusions: This analysis showed substantial variation on HAIs rates by ICU, but consistent device usage by ICU at VA facilities.  The results of this analysis should be interpreted with caution due to limited external validity. This limitation highlights the need to develop and implement a comprehensive surveillance system that includes device-associated infections at all VA facilities regardless of the hospital location where the device was used.