Navigation Links
Bloodstream infection surveillance inconsistent between institutions, U-M study shows
Date:10/8/2010

ANN ARBOR, Mich. A new study looking at how hospitals identify pediatric patients who develop catheter-associated bloodstream infections (CA-BSI) found significant inconsistencies in the methods used to report the number of patients who develop them.

The study, led by Matthew Niedner, M.D., assistant professor of Pediatrics and Communicable Diseases at U-M C.S. Mott Children's Hospital, was conducted by the National Association of Children's Hospitals and Related Institutions Pediatric Intensive Care Unit Focus Group. It appears in the October issue of the American Journal of Infection Control.

"There is an intense amount of attention being placed on measures of quality performance that have significant implications in pay-for-performance, and reimbursement," says Niedner, who led the study. "What you have is a desire to measure quality but a lack of perfect measures. Measures are often 'good enough' to enable quality improvement, but can leave undesirable ambiguity when used comparatively as a metric of clinical performance."

Bloodstream infections are the most common hospital-associated infections in pediatric intensive care units (PICUs) and a significant source of in-hospital deaths, increased length of stay and added medical costs. Both adult and pediatric patients who have catheters inserted into their blood vessels face increased risk of developing an infection along the invasive plastic devices. The infections can become deadly as they spread into the bloodstream.

One hundred forty-six respondents from five professions in 16 PICUs completed surveys with a response rate of 40%. All 10 infection control departments reported inclusion or exclusion of central line types inconsistent with the Centers for Disease Control and Prevention CA-BSI definition, half calculated line-days inconsistently, and only half used a strict, written policy for classifying BSIs. Infection control departments report substantial variation in methods, timing, and resources used to screen and adjudicate BSI cases.

More than 80% of centers reported having a formal, written policy about obtaining blood cultures, but less than 80% of these address obtaining samples from patients with central venous lines, and any such policies are reportedly followed less than half of the time.

All of the surveyed infection control practitioners in the study said they used the Centers for Disease Control and Prevention's definition for CA-BSI, but none actually did, says Niedner. This has significant implications in the era of mandatory public reporting, pay-for-performance and Medicare's 'never events.'" The Centers for Medicare & Medicaid Services lists CA-BSI as a never event, and no longer reimburses for such hospital-acquired infections.

The study also showed that more aggressive surveillance efforts correlate with higher catheter-associated bloodstream infections rates. This suggests "that the harder one looks for CA-BSIs, the more likely they are to find them," Niedner says.

"From an internal perspective, you want an aggressive surveillance system that is inclusive of all possible cases, but from a public reporting or pay-for-performance standpoint, you'd like to exclude as many cases as you can," Niedner says. "There are no definitive national standards as to how to go about doing CA-BSI surveillance at the clinical practice level. It leaves wiggle room that pits hospital economics and reputation against quality improvement teams."

"If you are interested in improving quality of care, you look hard, if you're interested in reputation and reimbursement, maybe you don't look so hard," Niedner adds.

The study's findings offer a compelling opportunity for hospitals to improve their CA-BSI surveillance as a means to promote valid comparison among institutions, Niedner says. Current publicly reported data show that some hospitals report a four-fold difference in CA-BSI rates.

The current system makes it difficult to identify best performers, he adds. "You have to ask yourself, 'Is it because their care practices are good or is it because their surveillance is weak?"'

Niedner hopes this work spurs further research into improving hospital surveillance for such infections. Improved understanding of this variability and awareness of the potential consequences provides an opportunity and rationale to define CA-BSI surveillance best practices and work toward standardizing them across institutions, he adds.

"Many problems become more manageable when we standardize procedures," he says. "Various professional bodies have put forward recommendations for CA-BSI surveillance, but not at the level that will give it real traction. It's going to take a national entity endorsing standardized surveillance practices to improve the validity of institutional comparisons."


'/>"/>

Contact: Margarita B. Wagerson
mbauza@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

Related medicine news :

1. Study of bloodstream infections reveals inconsistent surveillance methods and reporting
2. UCI gets major funding to study ways of preventing drug-resistant staph infections
3. NCH investigators receive grant to distinguish bacterial infections from viral infections in infants
4. Nonstick coating of a protein found in semen reduces HIV infection
5. Study: Doctors overprescribe antibiotics for respiratory infections
6. High Blood Sugar Levels Increase Infection Risk From General Surgery
7. Childhood viral infection may be a cause of obesity
8. Disease transmission model says media coverage cuts infection rate and pandemic extent
9. Latent HIV infection focus of NIDAs 2010 Avant-Garde Award
10. Pharmaceutical conservation key to slowing rise of antibiotic-resistant infections
11. Treatment for S. aureus skin infection works in mouse model
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/12/2017)... ... ... Planet Fitness, one of the largest and fastest growing franchisors and operators ... location in Covington, LA at 401 N. U.S. Highway 190, in January of 2018. ... in the Holiday Square shopping center. Its location allows it to serve both Covington ...
(Date:10/12/2017)... ... October 12, 2017 , ... The American College of Medical Informatics ... PhD, FACMI, during the Opening Session of AMIA’s Annual Symposium in Washington, D.C. AMIA’s ... of Morris F. Collen, a pioneer in the field of medical informatics, this prestigious ...
(Date:10/12/2017)... ANGELES (PRWEB) , ... October 12, 2017 , ... ... Parsa Mohebi Hair Restoration, has recently contributed a medical article to the newly ... on cosmetictown.com. Dr. Mohebi’s article spotlights the hair transplant procedure known as ...
(Date:10/12/2017)... ... ... On Saturday, October 21, the Health & Wellness Center at Florida Hospital ... for the American Heart Association Heart Walk. Teams of up to 10 people can ... their treadmills moving for 5 hours. Treadmills will start at 7:00 p.m. on Saturday, ...
(Date:10/12/2017)... ... October 12, 2017 , ... ... in property taxes a year. In some states—like New York, New Jersey, Massachusetts, ... contrast, many overseas retirement havens have extremely low property-tax rates, which contributes to ...
Breaking Medicine News(10 mins):
(Date:9/28/2017)... , Sept. 28, 2017 Hill-Rom Holdings, Inc. ... earnings conference call and webcast on Friday, November 3, ... (EDT) and ending at approximately 8:30 a.m. (CDT) / ... the company,s 2017 financial performance and guidance for 2018, ... initiatives to enhance operational performance, and long-range financial outlook ...
(Date:9/25/2017)... R.I. , Sept. 25, 2017  EpiVax, ... assessment, vaccine design, and immune-engineering today announced the ... on the development of personalized therapeutic cancer vaccines. ... has provided exclusive access to enabling technologies to ... Eng., MBA will lead EpiVax Oncology as Chief ...
(Date:9/19/2017)... Sept. 19, 2017   ZirMed Inc ., a recognized ... announced that it has been ranked #1 by its users ... Rankings 2017 User Survey. ZirMed was recognized as the ... hospitals and medical centers over 200 beds and holds one ... technology user survey history. ...
Breaking Medicine Technology: