tag:blogger.com,1999:blog-32053362.post5310461521603112093..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Central Line Infection UpdatePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-32053362.post-79313487226012296072009-07-22T14:13:49.547-04:002009-07-22T14:13:49.547-04:00See comments well above where we discuss this.See comments well above where we discuss this.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-54965087732764749362009-07-22T13:03:33.794-04:002009-07-22T13:03:33.794-04:00As an Epidemiologist, I just want to note that the...As an Epidemiologist, I just want to note that the denominator used is 1,000 patient days. NHSN benchmarking traditionally uses central line days as a denominator because it is more reflective of the rate of infection. When patient days is used, it actually is a misrepresentation of the correct population be assessed. It is still a remarkable trend but not comparable to national benchmarking.LosAngelesEpidemiologistnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-56961402333818865692008-06-05T08:54:00.000-04:002008-06-05T08:54:00.000-04:00A follow-up note from our infection control folks:...A follow-up note from our infection control folks:<BR/><BR/>I would add that we have recently been looking at this issue as we validate our method of hand gathering catheter days in the ICUs for public reporting (until the IS solution is available in the fall). As we had suspected, in the majority of units, most patients have a central line each day. So, in most ICUs, one patient day equals one catheter day. We do see some exceptions, such as the CCU, where not every patient has a central line each day. Note that the CDC states that if you do not have catheter day data, you should use patient days as the denominator. This is not allowable when you report data to the CDC (as we will start to do for public reporting).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-13790097069335911762008-06-03T17:19:00.000-04:002008-06-03T17:19:00.000-04:00I was wrong! The denominator we use is, in fact, ...I was wrong! The denominator we use is, in fact, all ICU patient days, not catheter days. I learned today that we do not yet have a good method for counting catheter days. We are putting in a new ICU monitor system, which should allow us to do this.<BR/><BR/>As I note above, this undermines the interpretation I have presented of the number. While it is still useful -- if we assume a relatively constant mix of catheterized vs non-catheterized patients -- it is less so if Parker's hypothesis is correct, i.e., fewer catheterized patients. His point may amount to a rounding error, or it might be more significant. Hard to know.<BR/><BR/>Meanwhile, though, the state has mandated that hospitals start reporting infections relative to catheter days, which we will have to do by hand until our new IS is in place.<BR/><BR/>So, apologies if I have overstated the impact of this somewhat. That should in no way take away from the fine work people have done or the fact that every single infection still receives a full root-cause review.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-58115916693878369342008-06-03T14:38:00.000-04:002008-06-03T14:38:00.000-04:00We rely heavily on IHI advice on these matters, bu...We rely heavily on IHI advice on these matters, but I'll also pass along your inquiry to folk here.<BR/><BR/>Best of luck.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-43992227066190818522008-06-03T12:21:00.000-04:002008-06-03T12:21:00.000-04:00PaulI am the Administrator of a hospital in the Pa...Paul<BR/><BR/>I am the Administrator of a hospital in the Pacific Northwest and we have been successful in implementatin of the VAP Best Bundles - it's been over 27 months now. We're now moving on to UTIs and BSIs. Any advice on bundles that work that could be shared with our team?<BR/><BR/>ThanksUnknownhttps://www.blogger.com/profile/11266254709828680173noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-39357678955834491872008-06-02T07:27:00.000-04:002008-06-02T07:27:00.000-04:00Oh, thanks for clarifying the question. Yes, of c...Oh, thanks for clarifying the question. Yes, of course, it is the latter. Otherwise, it would not be meaningful.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-86503753970605874272008-06-02T07:23:00.000-04:002008-06-02T07:23:00.000-04:00I think Parker may be asking if your denominator i...I think Parker may be asking if your denominator is ALL patient-days in ICU (including patients with no catheter), or only patients-with-indwelling-catheter-days in the ICU. I suspect and hope it's the latter.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-29371064828606696072008-06-01T22:07:00.000-04:002008-06-01T22:07:00.000-04:00By indwelling, you mean ICUs + regular med/Surg fl...By indwelling, you mean ICUs + regular med/Surg floors, I take it. We do keep track of those, too, and the numbers outside of the ICUs are very, very small.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-11271633406887192232008-06-01T16:07:00.000-04:002008-06-01T16:07:00.000-04:00While I share the enthusiasm for reducing the nume...While I share the enthusiasm for reducing the numerator of line infections, I wonder if the denominator of patient-days in the ICU is somewhat diluted over the past few years. I don't have the numbers, but our chair of medicine recently told the department that we have the busiest ICUs in Boston, and I think with the Triggers system, there is pressure to put less-sick patients in the ICU "just in case," meaning that the average ICU patient has a lower APACHE-II s score than a few years ago--and is therefore less likely to have a central line at all than a few years back. <BR/><BR/>I guess what I am asking is, wouldn't the number of patient-days of indwelling central lines be a more appropriate denominator?Parkerhttps://www.blogger.com/profile/00578760060845449671noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-43281617415422049672008-06-01T05:46:00.000-04:002008-06-01T05:46:00.000-04:00Paul, I admire your leadership of this rate of imp...Paul, I admire your leadership of this rate of improvement...seems that with committed front line microsystem teams, evidence-based ideas for change, and curious leaders with a never-ending mission to make care better for patients, you show better care week after week. Your transparency on results is energizing! Thanks to you and all at BIDMC for leading the way on improving care.<BR/>Maureen BisognanoAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-23148083942751741102008-05-30T13:17:00.000-04:002008-05-30T13:17:00.000-04:00CONGRATULATIONS. It's been very interesting to fol...CONGRATULATIONS. It's been very interesting to follow this issue from the beginning of the effort to this result.Anonymousnoreply@blogger.com