title: Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections in Adult Hospitalized Patients.
abstract: BACKGROUND
  Parenteral nutrition is associated with increased central line-associated bloodstream infections (CLABSIs). Electronic databases are important for identifying independent risk factors for prevention strategies. Our aims were to evaluate the utility of using electronic data sources to identify risk factors for CLABSIs, including parenteral nutrition (PN), and to assess the association between CLABSI and PN administration.
  
  
  METHODS
  Data were obtained for all discharges of adult patients in whom a central line was inserted between September 1, 2007, and December 31, 2008, in a large, academically affiliated hospital in New York City. CLABSI was defined electronically using a modified definition from the Centers for Disease Control and Prevention. A manual chart review was also undertaken to assess validity/reliability of the electronic database and gather additional information. Risk factors for CLABSI were examined using logistic regression.
  
  
  RESULTS
  Among 4840 patients, there were 220 CLABSIs, an incidence of 5.4 CLABSIs per 1000 central line days. Risk factors included PN (odds ratio [OR], 4.33; 95% confidence interval [CI], 2.50-7.48), intensive care unit stay (OR, 2.26; 95% CI, 1.58-3.23), renal disease (OR, 2.79; 95% CI, 2.00-3.88), and immunodeficiency (OR, 2.26; 95% CI, 1.70-3.00). Diabetes mellitus was associated with reduced CLABSI rates (OR, 0.63; 95% CI, 0.45-0.88).
  
  
  CONCLUSIONS
  The utility of electronic medical records for determining risk factors is limited by such things as free-text data entry. Using a hybrid between fully electronic and manual chart review, reliable data were obtained. PN is associated with a high risk for CLABSI in a population highly selected for indications for PN.
authors.affiliation: Division of Preventive Medicine & Nutrition, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Ippolito
authors.affiliation: Center for Interdisciplinary Research to Prevent Infections, Columbia University, New York, New York Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York Columbia University School of Nursing, New York, New York.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.affiliation: Columbia University School of Nursing, New York, New York.
authors.forename: Jianfang
authors.initials: J
authors.lastname: Liu
authors.affiliation: Division of Preventive Medicine & Nutrition, Department of Medicine, Columbia University Medical Center, New York, New York Institute of Human Nutrition, Columbia University Medical Center, New York, New York dseres@columbia.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Seres
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000150:complications; D015994:Incidence; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000150:complications; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010288:Parenteral Nutrition / Q000009:adverse effects*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*
keywords: central line–associated bloodstream infection; central venous catheter; electronic medical records; life cycle; nutrition; nutrition support practice; parenteral nutrition; risk factors; sepsis