title: Denominator doesn't matter: standardizing healthcare-associated infection rates by bed days or device days.
abstract: OBJECTIVE
  To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator
  
  
  METHODS
  Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care
  
  
  METHODS
  Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections
  
  
  METHODS
  We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance.
  
  
  RESULTS
  A total of 7.9 million bed days were included. From 2011 to 2013, CAUTI decreased whether measured by device days (2.32 to 1.64, P=.001) or bed days (4.21 to 3.02, P=.006). CLABSI decreased when measured by bed days (1.67 to 1.19, P=.04). VAP rates and device utilization ratios for CAUTI, CLABSI, and VAP were not statistically different across time. Infection rates calculated with device days were strongly correlated with infection rates calculated with bed days (r=0.79-0.94, P<.001). Hospital relative performance measured by ordered rank was also strongly correlated for both denominators (r=0.82-0.96, P<.001).
  
  
  CONCLUSIONS
  These findings suggest that device days and bed days are equally effective adjustment metrics for comparing healthcare-associated infection rates between hospitals in the setting of stable device utilization.
authors.affiliation: 1Center for Innovations in Quality,Effectiveness, and Safety (IQuESt);Michael E. DeBakey VA Medical Center,Houston,Texas.
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Horstman
authors.affiliation: 5Operational Analytics and Reporting,Office of Informatics and Analytics,Veterans Health Administration,Department of Veterans Affairs,Washington, DC.
authors.forename: Yu-Fang
authors.initials: YF
authors.lastname: Li
authors.affiliation: 5Operational Analytics and Reporting,Office of Informatics and Analytics,Veterans Health Administration,Department of Veterans Affairs,Washington, DC.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Almenoff
authors.affiliation: 5Operational Analytics and Reporting,Office of Informatics and Analytics,Veterans Health Administration,Department of Veterans Affairs,Washington, DC.
authors.forename: Ron W
authors.initials: RW
authors.lastname: Freyberg
authors.affiliation: 1Center for Innovations in Quality,Effectiveness, and Safety (IQuESt);Michael E. DeBakey VA Medical Center,Houston,Texas.
authors.forename: Barbara W
authors.initials: BW
authors.lastname: Trautner
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D062905:Central Venous Catheters / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012015:Reference Standards; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D014600:Utilization Review