Comparison Of Central Line-Associated Bloodstream Infection Demographics, Pennsylvania 2009 – 2011

BACKGROUND:  Central line associated bloodstream infections (CLABSIs) are severe, costly healthcare associated infections.  Recent data demonstrate substantial national declines in CLABSI incidence.  Pennsylvania is one of the few states that mandates house-wide in-patient CLABSI reporting, and has observed a 44% decline since data analysis began in mid-2008.  To further explore the nature and character of these declines, we examined full-year CLABSI data from 2009 to 2011.  A state-wide hospital survey was conducted to assess use of CLABSI prevention measures and compare these activities to changes in CLABSI rates.   

METHODS:  PA data from the National Healthcare Safety Network were extracted for 2009, 2010, and 2011 and examined for differences by age, ward location, facility characteristics and device utilization ratio (DUR – central line days over patient days).  Rates were calculated per 1,000 catheter days.  The hospital survey was initiated in December 2012 using SurveyMonkey®.  Multivariate regressions were performed using SAS 9.2

RESULTS:  In 2009, there were 2,175 CLABSIs in 1.76 million central-line days (1.23 per 1000 CLDs); the numbers in 2010 were 1,606 CLABSIs in 1.73 million central-line days (rate 0.93); in 2011 1,540 CLABSIs in 1.73 million central-line days (rate 0.89).  There were no significant changes between 2009 and 2011 in the overall central line DUR, age distribution of CLABSI patients, ward distribution, facility size or medical school affiliation (MSA).  DUR stratified by hospital demographics also did not change from 2009 to 2011.  Preliminary analysis of hospital survey data from 41 hospitals found that 73% have employed CLABSI prevention measures since January 2009. 

CONCLUSIONS:  The declines in CLABSI rates seen in PA are occurring across all patient locations, patient age groups and hospital types, and are not due to reductions in central line usage.  Infection prevention measures have been implemented by the majority of hospitals in Pennsylvania, and they appear to be broadly effective. Further analysis of the prevention activity survey will be conducted to determine their relationship and impact on declines in CLABSI incidence.