Incidence of Patient Infections Related to Indwelling Catheters

The life-saving protocols and treatments of today’s medicine would have been unthinkable even a few decades ago. Unfortunately, many of these treatments carry some degree of risk to the patient. One of these risks is the risk of infection. According to the Centers for Disease Control (CDC), nosocomial or hospital-acquired infections affect approximately two million people annually.

Safe ways to perform invasive procedures are paramount to the staff at RML Specialty Hospital. Research shows that straightforward steps can be taken to reduce the incidence of infection. We are vigilant in our continuing efforts to minimize these risks to our vulnerable patient population.

Based on the medical complexity of our patients and the widespread use of catheters and other devices in their treatment, we closely monitor the occurrence of three major types of infections associated with indwelling catheters and devices: catheter-associated urinary tract infections (UTIs), central line infections (CLIs), and ventilator-associated pneumonias (VAPs).

To gauge our performance, RML uses comparative data from the National Healthcare Safety Network (NHSN), the surveillance system of the CDC. It should be noted that there is no current national database for long-term acute care hospitals. The NHSN reflects voluntary membership by a sample of acute care hospitals across the U.S. RML utilizes the benchmarks for infection rates establishedfor a Medical ICU.

The NHSN calculation for each infection is as follows:

The 50th percentile marks the national median. This means that half of the hospitals reporting have lower rates of infection and half have higher.

Catheter-associated Urinary Tract Infections (UTI)

Catheter-associated urinary tract infections are the most common of all hospital-acquired infections, accounting for nearly 80 percent. RML uses CDC guidelines to assess infection from an indwelling urinary catheter. A positive diagnosis requires a positive urine culture plus one of the following:

• Fever
• Urinary frequency
• Urinary urgency
• Dysuria

NHSN data reflects that 25 percent of its participants have a monthly rate of 1.8, and 50 percent have a rate of 3.8. RML’s fiscal year 2007 average monthly rate of catheter-associated UTIs is 2.9. Ranking between the 25th and 50th percentile means that RML performs better than approximately two-thirds of the hospitals in the database.

Central Line Infections

Central line infections are among the most deadly of all hospital-acquired infections. NHSN data reflect that 25 percent of its participating hospitals have a monthly rate of 0.8, and 50 percent have a rate of 2.2. RML’s fiscal year 2007 average monthly rate of central line-associated bloodstream infections is 1.4. Once again, RML is between the 25th and 50th percentile, performing better than approximately two-thirds of the reporting hospitals.

Ventilator-associated Pneumonias (VAPS)

There is no clear definition for ventilator – associated pneumonia. RML relies on the nationally recognized CDC definition for pneumonia, which requires two indicators for diagnosis – a positive chest X-ray (new or progressive infiltrate) plus one of the following:

• New onset of purulent sputum or change in sputum character
• Increased amount of secretion
• Positive culture (from trached aspiration, suction, or bronchoscopy)

NHSN data reflect that 25 percent of its participants have a monthly rate of 0.9, and 50 percent have a rate of 2.8. RML’s fiscal year 2007 average monthly rate for VAP is 2.6.