Can Inpatient Hospital Experiences Predict Central Line-Associated Bloodstream Infections?

Abstract

BackgroundFactors that increase the risk of central line-associated bloodstream infections (CLABSIs) are not fully understood. Recently, Hospital Compare began compiling data from hospital-required reporting to the CDC's National Healthcare Safety Network on CLABSIs in intensive care units (ICUs), at over 4,000 Medicare-certified hospitals in the United States, and made this data accessible on a central website. Also available on the same website are results from the Hospital Consumer Assessment of Healthcare Providers and Systems survey of patients' hospital experiences. Utilizing both databases, our objective was to determine whether patients' hospital experiences were significantly associated with increased risk for reported ICU CLABSI.Methods and FindingsWe conducted a zero-inflated Poisson regression analysis at the hospital level on CLABSI-observed cases by ICUs in acute care hospitals (n = 1987) in the United States between January 1, 2011, and December 31, 2011. During this period there were a total of 10,866 CLABSI cases and 9,543,765 central line days. In our final model, the percent of patients who reported that they “sometimes” or “never” received help as soon as they wanted was significantly associated with an increased risk for CLABSIs.ConclusionsUsing national datasets, we found that inpatients' hospital experiences were significantly associated with an increased risk of ICU reported CLABSIs. This study suggests that hospitals with lower staff responsiveness, perhaps because of an understaffing of nurse and supportive personnel, are at an increased risk for CLABSIs. This study bolsters the evidence that patient surveys may be a useful surrogate to predicting the incidence of hospital acquired conditions, including CLABSIs. Moreover, our study found that poor staff responsiveness may be indicative of greater hospital problems and generally poorly performing hospitals; and that this finding may be a symptom of hospitals with a multitude of problems, including patient safety problems, and not a direct cause.

Patients’ Perceptions of Care Are Associated With Quality of Hospital Care

“…Those chosen were overall hospital rating, willingness to recommend the hospital, communication with doctors, and responsiveness of staff, as others have demonstrated that these are representative of the HCAHPS questionnaire and are associated with technical quality of care. 8,10,15,17,18,22 Most of the relationships investigated demonstrated an association between higher patient satisfaction scores and better quality of medical care. Of the 52 possible relationships studied, 29 (56%) demonstrated a significant trend (P < .05).…”

Risk Factors for Central Line–Associated Bloodstream Infections in the Era of Prevention Bundles

“…Contemporary data on risk factors have limitations in terms of generalizability. [5][6][7]9 We found independent predictors of CLABSI included duration of CVC presence and more frequent CVC access-specifically, higher number of lab tests drawn. Although we found an association between number of intravenous medications given and CLABSI in bivariate analysis, this association was not seen in our multivariate analysis, possibly owing to limited power.…”

Do Clinicians Know Which of Their Patients Have Central Venous Catheters?

“…This theory might also explain greater observed awareness of CVCs among intensivists, because lower patient–provider ratios, coupled with standardization of process and a culture that is highly attuned to these devices, may make CVCs more “visible” in critical care settings (12). Conversely, the absence of such culture and the heterogeneous composition of care teams in non-ICU settings may inadvertently foster lack of CVC awareness (10, 20, 21). …”