Central Line Associated Infection Rates in USA

Question: 1: Writing an introduction .The introduction provides a detailed preview of the contents of the paper. 2: Calculates Central Line Associated Infection (CLABSI) rates from any hospital in USA and explains meaning of calculations. Write the definition of Incidence rates, Prevalence rates Incidence density rates, Attack rates, and Explanations of rates. Also, write Formulas for each calculation that is used to calculate the below definitions. Formula must be included in the paper as well. Calculations include: Used formula must be write. 1. Incidence rates. 2. Prevalence rates. 3. Incidence density rates. 4. Attack rates 3: Compares calculated rates above with National Healthcare Safety Network (NHSN) data. 4: The summary includes a detailed paragraph of what was presented in the paper. Answer: Introduction Healthcare associated infections are most commonly occurring incidences these days and have a rate of 5% in United States of America every year. CLABSI is one of the serious infections that are usually caused by the entry of germs in the bloodstream through central line for e g. Insertion of catheter etc. According to the progress report received from HAI (healthcare associated infections), among the national acute care hospitals, A significant decline has been found with 50% decrease in CLABSIs from 2008 to 2014 and in the long term acute care hospitals there is 9% decrease between 2013 and 2014. It is also found in researches that the rate of some targeted CLABSIs can decrease by 70% if the healthcare facilities, care teams, doctors and nurses are aware of such infectious problems and equipped with the required initiative to prevent such infections and a big number of hospitals have taken necessary steps to reduce such incidences. (Marsteller, 2014) CLABSI Rates in USA Hospitals Every year in United States, about 5% of the hospitalized patients are affected with HAIs out of which mortality of 12-25% has been reported to be the cases of CLABSIs which is very important, deadly and largely preventable. As per report from the centers for disease control and prevention (CDC), there are a big number of patients who are suffering from such infections in the ICUs at big hospitals of United States of America. In year 2001, approximately 43,000 cases of CLABSIs happened between the patients hospitalized in ICUs in the United States of America and this number decreased to 18,000 in calendar year 2009. This is significant reduction in such infections being happened in hospitals of USA. (Pronovost, 2006) The patients hospitalized in ICUs acquire a bigger risk of CLABSI because 48 out of 100 patients of them have infected from central venous catheters which results into more than 15 million central lines per year in the ICUs of hospitals in United States of America. As per reports, about twenty eight thousand (28,000) patients die annually in hospitals of United States of America from CLABSI and there are numerous efforts taken every day to decrease this amount. CLABSI Rate Calculation The rate of central line blood stream infection rate is calculated by dividing the count of central line associating bloodstream infections by the central line days and then multiplying them by one thousand (1000). It is calculated when the infection of the patient is confirmed by a laboratory within 48 hours before the development of BSI and there is no infection detected at any other site. To get the CLABSI rate calculated it must meet 3 basic criteria: Patient must have a pathogen in its culture from one or more blood cultures taken. Any one of the symptom (fever, chills or hypotension) must be present in the patient to direct him/her to be seen as CLABSI. If the patient is found to be of age less than one year then the symptoms like fever, hypothermia, apnoea or bradycardia must be present to go for CLABSI diagnosis. Example: In Hospital ABC, 5 patients have been detected with pathogen out of 110 patients hospitalized in the ICU, while total number of patients admitted in hospital were 1135 during period January 2016, out of which no one was of age less than 1 year. The total population treated in the hospital during last 2 years is 12450. Incidence rates Incident rate is the resultant of the frequency with which a disease takes place in a population over a particular span of time. It can be measured as below:- Incidence rates = (new incidences occupying during a given period of time / total population on risk during the same time period) For given example, Incidence rate = (5 / 110) x 100 % = 4.54% This is near to the national rate of incidences. Prevalence rates Prevalence rate is the percentage of persons in a population who have detected with a particular disease at a specific time. Prevalence rate = (all new cases and pre-active cases during a time period / total population during the same time period) For given example, Prevalence rate = (5 / 1135) x 100 % = 0.44 % Incidence density rates It is the measure of number of diseases occurring over a population at a particular period of time. Incidence density = (number of disease onset) / (sum of person time @ risk) For example, the number of diseases onset at the time of hospitalization is 13 in the period of 2years Then, 13 / (12450-2) = 13 / 12448 = 0.10% This shows that the average rate of patients with incidence density is very much in accordance with the NHSN. Attack Rates It is the measure of new cases in a population in a specific time period separated by the population at risk at the beginning of time period multiplies by 100. Attack rates = (number of new cases observed at a period of time / total population at risk) * 100 For example, number of new cases observed are 46 Total population at risk is 12450 Therefore, (46 / 12450) * 100% = 0.36 % This is under control as per the data received from NHSN. National Healthcare Safety Network (NHSN) Data Comparison All the cases observing CLABSI in the hospitals of USA are submitted into the national database. These records are either entered directly or through CDC and NHSN .in 2009 annual survey, around 20 states were subjected to be the part of a project in the month of may and September, for the assessment purposes. From the analysis of recorded data these values came in from which are mentioned in the table below. Average CLABSI Rates with units reporting during ANY of the five time periods Information detailed reflective of data entered as of October 7, 2010. Done by NHSN Baseline 12 months prior to intervention cycle 1 Months 1-3 post intervention cycle 2 Months 4-6 post intervention cycle 3 Months 7-9 post intervention cycle 4 Months 10-15 post intervention participating States 20 20 20 20 20 Reporting units 384 436 435 434 402 Average CLABSI per unit 3.12 0.93 0.72 0.65 0.64 Average CL days per unit 1680 510 508 507 556 Average BSI rate 1.80 1.64 1.31 1.14 1.17 95% confidence interval (1.53 , 2.08) (1.39 , 1.89) (1.09 , 1.53) (0.94 , 1.35) (0.89 , 1.44) Change from baseline* NA -0.19 -0.53 -0.61 -0.59 @ 95% confidence interval (-0.58, 0.20) (-0.89,- 0.17) (-0.97,-0.25) (-1.01,-0.17) * Calculated on unpaired assessment of unit rates between time periods Summary A decline in the number of CLABSIs is seen between 2001 and 2009 from 3.64% to 1.65%.the national project team is highly alert in conducting these projects in future also so as to examine the change in values for such kind of infections. This will enable to create prevention awareness at a more progressive level. In the above mentioned data it is clear that in most parts of United States these type of infectious diseases are common but are being rapidly controlled also due to sudden and quick measurements taken by the national healthcare safety network. In 2001, an estimated number of 43,000 CLABSI patients were registered or admitted in ICUs in United States whereas in 2009 this number got highly reduced to 23,000 which is a good 58% reduction found in United States. (Richard, 1999) References Berenholtz, S., Lubomski, L., Weeks, K., Goeschel, C., Marsteller, J., Pham, J. et al. (2014). Eliminating Central LineAssociated Bloodstream Infections: A National Patient Safety Imperative.Infect Control Hosp Epidemiol,35(01), 56-62. https://dx.doi.org/10.1086/674384 Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S. et al. (2006). An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU.New England Journal of Medicine,355(26), 2725-2732. https://dx.doi.org/10.1056/nejmoa061115 Richards, M., Edwards, J., Culver, D., Gaynes, R. (1999). Nosocomial Infections in Pediatric Intensive Care Units in the United States.PEDIATRICS,103(4), e39-e39. https://dx.doi.org/10.1542/peds.103.4.e39 Vital Signs: Central LineAssociated Blood Stream InfectionsUnited States, 2001, 2008, and 2009. (2011).Annals of Emergency Medicine,58(5), 447-450. https://dx.doi.org/10.1016/j.annemergmed.2011.07.035