Abstract: Validating Reductions in Device Infections: Comparing Ventilator Associated Pneumonias (VAPs) and Central Line Associated Blood Stream Infections (CLABSIs) to Lower Respiratory Infection (LRIs) and Primary Bloodstream infections (BSI) (21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (April 1-4, 2011))

Saturday, April 2, 2011

Trinity Ballroom (Hilton Anatole)

Odaliz Abreu Lanfranco, MD , Detroit Medical Center, Wayne State University, Detroit, MI

Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI

Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI

Kayoko Hayakawa, MD, PhD , Detroit Medical Center, Wayne State University, Detroit, MI

Beth Dziekan, MS , Detroit Medical Center, Wayne State University, Detroit, MI

Thomas Chevalier, RN , Detroit Medical Center, Wayne State University, Detroit, MI

Connie G. Bohlinger, M(ASCP) , Detroit Medical Center, Wayne State University, Detroit, MI

MIchelle Fitch, BS , Detroit Medical Center, Wayne State University, Detroit, MI

Elaine Flanagan, MSA , Detroit Medical Center, Wayne State University, Detroit, MI

Keith .S Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI

Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI

Background:

Beginning 2009 the Centers for Medicare and Medicaid Services (CMS) no longer reimbursed for the treatment of many preventable errors, including those considered “Never Events” such as central line associated bloodstream infection (CLABSIs) and Ventilator Associated Pneumonias (VAPs). Being tied to compensation with increased public scrutiny, surveillance definitions are now being used as clinical quality metrics and there is an increasing need to validate that they are being applied in a standardized manner across healthcare systems.

Objective:

To assess CLABSI and VAP rates in our institution and compare them to similar non - device infections (primary bloodstream infections [BSIs] that are not catheter associated and lower respiratory infections [LRIs] other than VAPs) that have not yet been linked to compensation or mandatory public reporting.

Methods:

Infection control data from 5 intensive care units (ICUs) in Detroit Receiving Hospital, Detroit, MI was reviewed from 2007 to 2010 and the rates of VAPs, LRIs, CLABSIs, and primary BSIs (PBSI) were analyzed. CDC definitions were used and PBSIs were defineded as isolating a recognized pathogen cultured from one or more blood cultures not related to an infection at another site and not associated with central venous catheters.

Results:

During the study period there was a significant decrease in VAP rates from 4.7 to 0.8 (p<0.001), and a non-significant increase in LRI rates from 0.6 to 1.1 (p=0.2); a decrease in CLABSI rates from 3.6 to 0.9 (p<0.001) , and a non-signficiant decrease in PBSI rates from 0.4 to 0.3 (p=1) – see Table.

Conclusions:

There was a significant decrease in device associated events (VAPs and CLABSIs) without any significant change in non-device associated events (LRIs and PBSIs) indicating a true reduction in device related infections.

Infection Rates per 1000 ICU Days

Year

VAP

LRI

CLABSI

PBSI

2007

4.7

0.6

3.6

0.4

2008

3.2

0.7

2.6

0.5

2009

1.6

1.6

2.3

0.6

2010

0.8

1.1

0.9

0.3

Year	VAP	LRI	CLABSI	PBSI
2007	4.7	0.6	3.6	0.4
2008	3.2	0.7	2.6	0.5
2009	1.6	1.6	2.3	0.6
2010	0.8	1.1	0.9	0.3

238 Validating Reductions in Device Infections: Comparing Ventilator Associated Pneumonias (VAPs) and Central Line Associated Blood Stream Infections (CLABSIs) to Lower Respiratory Infection (LRIs) and Primary Bloodstream infections (BSI)