Incidence of Patient Infections Related to Indwelling Catheters
The life-saving protocols and treatments of today’s medicine would have been unthinkable even a few decades ago. Unfortunately, many of these treatments carry some degree of risk to the patient. One of these risks is the risk of infection. According to the Centers for Disease Control (CDC), nosocomial or hospital-acquired infections affect approximately two million people annually.
Safe ways to perform invasive procedures are paramount to the staff at RML Specialty Hospital. Research shows that straightforward steps can be taken to reduce the incidence of infection. We are vigilant in our continuing efforts to minimize these risks to the patients we serve.
Based on the medical complexity of our patients and the widespread use of catheters and other devices in their treatment, we closely monitor the occurrence of three major types of infections: catheter-associated urinary tract infections (CAUTIs), central line infections (CLABSIs), and ventilator-associated pneumonias (VAPs).
To gauge our performance, RML uses comparative data from
the National Healthcare Safety Network (NHSN), the surveillance system
database of the Centers for Disease Control (CDC). Currently, there
is no mandatory database for long-term acute care hospitals. Data
reflected in the NHSN data base is reported on a voluntary basis.
When making comparisons of the various rates, it should
be noted the NHSN data is not risk- adjusted. Some LTCHs have the
capabilities of taking very complex patient populations, transplant
patients for instance, or patients with multiple organ system failure.
These complex patients are at much greater risk for developing
complications and infections because of the very nature of their
illnesses. Hospitals that provide care for these more complex patients
may or may not have higher (non risk-adjusted) rates of infections than
hospitals that do not care for such complex patients.
The NHSN calculation for each infection is as follows:
| Number of device-associated infections |
x 1000 = Rate of infection per 1000 device days |
| Number of device days
|
The 50th percentile marks the national median. This means that half of the hospitals reporting have lower rates of infection and half have higher.
Catheter-associated Urinary Tract Infections (CAUTIs)
Catheter-associated urinary tract infections are the most common of all hospital-acquired infections, accounting for nearly 80 percent. RML uses CDC guidelines to assess infection from an indwelling urinary catheter. A positive diagnosis requires a positive urine culture plus one of the following:
- Fever
- Urinary frequency
- Urinary urgency
- Dysuria
NHSN’s data from 2010 reflects the top 25% have a rate of
0.8 and the top 50% of LTCHs have a rate of 2.4. For fiscal year
2012, RML’s CAUTI rate was 1.4
Catheter Associated Blood Stream Infections (CLABSIs)
CLABSIs are the most severe of all hospital
acquired infections. NHSN’s data from 2010 shows the top 25% of LTCHs
have a rate of 0.3. The top 50% of the hospitals have a rate of 1.1.
RML’s fiscal year 12 rate was 2.6. RML utilizes all of the evidence
based interventions and protocols developed to decrease the risk of
CLABSI infections.
Ventilator-associated Pneumonias (VAPS)
There is no widely accepted definition for ventilator-associated pneumonia. RML relies on the nationally recognized CDC definition for pneumonia, which requires two indicators for diagnosis — a positive chest X-ray (new or progressive infiltrate) plus one of the following:
- New onset of purulent sputum or change in sputum character
- Increased amount of secretion
- Positive culture (from trached aspiration, suction, or bronchoscopy)
NHSN’s 2010 data reflects the top 25% and 50% of hospital
reporting no Ventilator Associated Pneumonia (VAP) infections. In
fiscal year 2012, RML’s VAP rate was 3.6.
