Eliminating CLABSI, A National Patient Safety Imperative: Final Report Companion Guide

Outcomes

Adult ICUs


Section Summary

  • Data from over 1,100 adult ICUs were examined.
  • CLABSI rates were reduced from 1.915 at baseline to 1.133 at quarter six, a relative reduction of over 40 percent.
  • Variability in relative reduction was found by cohort and hospital characteristics.

A total of 1,185 adult ICUs reported at least one data point. Units that formally withdrew were excluded (n=50)3, and units that never reported post-baseline data were excluded (n=11), resulting in a final analytic sample of 1,124 units. One unit did not report data between quarter one and quarter six but did report during quarters seven and eight. On average, units had less than one missing post-baseline quarter worth of data (mean=0.36; stdev=0.96; median=0).

Overall

Overall CLABSI rates over time can be found in Figure 8. Table 2 illustrates the number of units reporting for each time period. Figure 9 illustrates the percentage of units reporting a rate of zero (shown in dark blue) or less than one (shown in light blue) during each time period. At baseline 30 percent of units reported a rate of zero. At quarter six, this percentage more than doubled with 68 percent of units reporting a rate of zero. Summary results for all adult ICUs can be found in Table 3.

Figure 8. Adult ICU CLABSI rate overall over time


Table 2. Number of ICUs reporting data at each time point

Baseline Q1 Q2 Q3 Q4 Q5 Q6
977 1,078 1,083 1,088 1,058 1,026 1,004

 

Figure 9. Percent of reporting ICU units with CLABSI rate of zero or less than one, all cohorts


* Percentage of units calculated as number of units with a rate of zero or less than one divided by the total number of units reporting during the time period.

Table 3. Summary for adult ICU cohorts 1-6 through quarter 6

  Pre-Intervention Post-Intervention
Baseline Q1 Q2 Q3 Q4 Q5 Q6
12 Months Months
1-3
Months
4-6
Months
7-9
Months
10-12
Months
13-15
Months
16-18
Number of States Reporting 46 45 46 46 46 45 44
Number of Units Reporting 977 1,078 1,083 1,088 1,058 1,026 1,004
Average CLABSIs/Unit 3.318 0.870 0.729 0.669 0.571 0.562 0.518
Average CL Days/Unit 1,733 487 483 488 467 459 457
Rate:
(Infections/Days)x1,000
1.915 1.785 1.511 1.372 1.221 1.225 1.133
Relative Reduction n/a -7% -21% -28% -36% -36% -41%

By Cohort

Figure 10. CLABSI rate by cohort over time for adult ICUs


Table 4. Number of ICUs reporting data at each time point by cohort*

Cohort Baseline Q1 Q2 Q3 Q4 Q5 Q6
Cohort  1 275 280 281 290 285 291 288
Cohort  2 244 290 290 292 282 267 282
Cohort  3 80 80 80 78 78 77 73
Cohort  4 152 183 187 186 185 183 178
Cohort  5 129 145 146 145 141 131 126
Cohort  6 97 100 99 97 87 77 57

* Note: As of the October 15, 2012, extract, the sixth project quarter for cohort 6 had not concluded.

By Hospital Characteristics

Figure 11. Adult ICU CLABSI rate overall over time by hospital characteristic


* Critical access hospitals (n=23) experienced one infection in 284 central line days (the lowest number of central line days reported during any quarter for critical access hospitals) resulting in a rate of 3.52 for quarter six.

Table 5. Number of ICUs reporting data at each time point by hospital characteristics

Hospital Characteristics Baseline Q1 Q2 Q3 Q4 Q5 Q6
In A System 584 622 624 624 609 594 575
In Largest 100 US Cities 220 229 230 228 226 228 212
Critical Access Hospital 19 21 21 22 22 22 19
Rural Hospital 155 180 183 183 178 172 165
Teaching Hospital 447 462 463 464 451 441 424

By Bed Size

Figure 12. Adult ICU CLABSI rate overall over time by hospital bed size


Table 6. Number of ICUs reporting data at each time point by hospital bed size

Hospital Bed Size Baseline Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8
0-100 116 138 140 141 141 139 133 121 106
101-175 135 148 151 148 144 137 134 113 96
176-250 132 137 137 133 127 122 111 93 80
251-325 113 119 119 119 113 109 104 98 89
326-400 99 102 102 106 99 96 94 86 68
>400 278 286 286 288 285 283 270 250 233

3. This number does not reflect units that formally withdrew but had not submitted any data. For details regarding project withdrawal see Participation section.

Page last reviewed January 2013
Internet Citation: Outcomes. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-final-companion/clabsicomp4.html