National Estimates of Central Line-Associated Bloodstream Infections in Critical Care Patients
National Estimates of Central Line-Associated Bloodstream Infections in Critical Care Patients
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DOI：
10.1086/670629
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发表时间：
2013-06-01
影响因子：
4.5
通讯作者：
Jernigan, John A.
中科院分区：
文献类型：
--
作者：
Wise, Matthew E.;Scott, R. Douglas;Jernigan, John A.
OBJECTIVE.最近的研究表明，通过实施循证预防实践，中心静脉导管相关血流感染（CLABSI）是可以预防的。自20世纪70年代以来，医院已向疾病控制和预防中心（CDC）报告了CLABSI数据，这为描述CLABSI随时间推移的全国影响提供了机会。我们的目标是描述美国重症监护患者CLABSI的年度数量变化。蒙特卡罗模拟。设置。美国急性护理医院。患者。非新生儿重症监护患者。我们获得了几乎所有美国医院的患者日管理数据，并应用国家医院感染监测和国家医疗安全网络系统的CLABSI率来估计1990-2010年期间全国重症监护患者的CLABSI年度数量以及自1990年以来预防的CLABSI数量。我们估计，1990-2010年期间，美国非新生儿重症监护患者中有462，000至636，000例CLABSI。CLABSI利率的降低导致CLABSI比1990年以来利率保持不变的情况下减少了104 000至198 000人。2010年有15，000例非新生儿重症监护患者的医院发作CLABSI; 70%发生在中型和大型教学医院。过去20年来，在减少美国重症监护患者CLABSI发生率方面取得了实质性进展。重症监护CLABSI集中在中型和大型教学医院表明，有针对性的方法可能是必要的，以继续实现减少全国重症监护CLABSI。
OBJECTIVE. Recent studies have demonstrated that central line-associated bloodstream infections (CLABSIs) are preventable through implementation of evidence-based prevention practices. Hospitals have reported CLABSI data to the Centers for Disease Control and Prevention (CDC) since the 1970s, providing an opportunity to characterize the national impact of CLABSIs over time. Our objective was to describe changes in the annual number of CLABSIs in critical care patients in the United States.DESIGN. Monte Carlo simulation.SETTING. US acute care hospitals.PATIENTS. Nonneonatal critical care patients.METHODS. We obtained administrative data on patient-days for nearly all US hospitals and applied CLABSI rates from the National Nosocomial Infections Surveillance and the National Healthcare Safety Network systems to estimate the annual number of CLABSIs in critical care patients nationally during the period 1990-2010 and the number of CLABSIs prevented since 1990.RESULTS. We estimated that there were between 462,000 and 636,000 CLABSIs in nonneonatal critical care patients in the United States during 1990-2010. CLABSI rate reductions led to between 104,000 and 198,000 fewer CLABSIs than would have occurred if rates had remained unchanged since 1990. There were 15,000 hospital-onset CLABSIs in nonneonatal critical care patients in 2010; 70% occurred in medium and large teaching hospitals.CONCLUSIONS. Substantial progress has been made in reducing the occurrence of CLABSIs in US critical care patients over the past 2 decades. The concentration of critical care CLABSIs in medium and large teaching hospitals suggests that a targeted approach may be warranted to continue achieving reductions in critical care CLABSIs nationally.