4053.0: Tuesday, November 14, 2000 - 9:30 AM

Abstract #15538

How Organizational Factors Affect Blood Stream Infection Rates: A Multi-hospital Study

Barbara I. Braun, PhD1, Stephen B. Kritchevsky, PhD2, Steven Solomon, MD3, Lynn Steele, MS, CIC3, Edward Wong, MD4, Bryan Simmons, MD5, and Cheryl Richards, BSN, RRA1. (1) Division of Research, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd, Oakbrook Terrace, IL 60181, 630-792-5928, bbraun@jcaho.org, (2) University of Tennessee, (3) Centers for Disease Control and Prevention, (4) Veterans Affairs Medical Center, Richmond Virginia, (5) Methodist Health System, Memphis TN

Do hospital policies and practices related to ICU infection control surveillance and nurse staffing levels influence the outcome for patients at risk of developing blood stream infections (BSI)? The Evaluation of Processes and Indicators in Infection Control (EPIC) Study evaluated the relationships between processes of care, organizational characteristics and patient outcome (BSI) so that hospitals can better understand what quality of care factors influence their rate of blood stream infection. This prospective cohort study tracked a random sample of patients and all ICU BSI's over 13 months. The outcome measure was determined per CDC's NNIS protocol. The population studied consisted of 55 hospitals (40 domestic and 15 international) and approximately 50 sample patients with central vascular catheters per hospital in adult medical, surgical, and trauma ICUs. Fifty-three sites responded to the survey (98%). A proxy measure of hospital-wide active BSI surveillance ( ratio of total # blood cultures to total patient days) ranged from 0.006 to 0.26 with a mean of 0.10 (sd=0.06). 114 persons conducted ICU infection surveillance; the mean hours per week per person dedicated to surveillance was 6.20 (sd=6.90; min=0.75 max=40). The mean ratio of total RN hours to total patient days in the ICU was 13.8 (s.d.=4.4; range 0.44 to 25.3). The percentage of hospitals utilizing agency staff in the ICU was 36% and "floaters" was 64%. Additional analyses will identify which organizational policies/ practices are associated with BSI so they can be targeted for quality improvement to reduce the incidence of this serious adverse outcome.

Learning Objectives: At the conclusion of the session, the participant will be able to 1) describe how organizational policy and procedures influence patient outcome and 2) identify patient and practitioner factors associated with blood stream infections

Keywords: Quality Improvement, Infectious Diseases

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA