The impact of hospital practice on central venous catheter associated bloodstream infection rates at the patient and unit level: a multicenter study.
OBJECTIVE
Little is known about factors driving variation in bloodstream infection (BSI) rates between institutions. The objectives of this study are to (1) identify patient, process of care, and hospital factors that influence intensive care unit (ICU)-level BSI rates and (2) compare those factors to individual risk factors identified in a cohort analysis.


METHODS
In this multicenter prospective observational study, the authors measured the process of care for 2970 randomly sampled central venous catheter insertions over 13 months.


METHODS
Medical, surgical, and medical/surgical ICUs of 37 domestic and 13 international hospitals.


RESULTS
Significant correlates of unit-level BSI rates were percentage of female patients, patients on dialysis, ICU bed size, percentage of practitioners with low numbers of previous insertions, and percentage inserted by nurses. Patient-level analysis identified gender, age, posttransplant, postsurgery, and use of the line for parenteral nutrition.


CONCLUSIONS
Factors that influence unit-to-unit variation may differ from factors identified in studies of individual patient risk.
Kritchevsky
Stephen B
SB
Department of Internal Medicine, Wake Forest University Schol of Medicine, USA.
Braun
Barbara I
BI
Kusek
Linda
L
Wong
Edward S
ES
Solomon
Steven L
SL
Parry
Michael F
MF
Richards
Cheryl L
CL
Simmons
Bryan
B
D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D017848:Blood-Borne Pathogens; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000592:standards; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D019049:Developed Countries / Q000706:statistics & numerical data; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D014481:United States / Q000453:epidemiology