Central line-associated bloodstream infection (CLABSI) rates are important markers for patient safety and the focus of increasing public health, payer, regulatory, and public interest. It is estimated that more than half of CLABSIs may be preventable if hospitals adhere to all of the recommended central line insertion practices (CLIP), which together are called a bundle, for each central line insertion. This is the sixth public report by the California Department of Public Health (CDPH) on CLABSIs and CLIP, and the fifth using information submitted by California hospitals to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). This report presents California average and hospital-specific CLABSI rates and CLIP adherence percentages for the reporting period January through December 2014. As in prior reports, data are grouped by patient care locations where patients with similar medical conditions receive similar levels of care across hospitals. We provide percentage changes in California average rates in 2014 compared to the same twelve-month period, January through December 2013. Monitoring and reporting California CLABSI rates and CLIP adherence percentages by patient care locations provide important information to assess CLABSI rates and CLIP adherence within and between hospitals. These data also provide information for targeting CLABSI prevention resources in California. Definitions, including CDPH patient care locations, methods, and limitations associated with this report are summarized in the below Technical Notes.
In this report, we present hospital-specific CLABSI standardized infection ratios (SIRs) and 95% confidence intervals (CIs) for general acute care hospitals, other than long-term and rehabilitation acute care hospitals. For CLABSI, the SIR is adjusted for different patient care locations. Adjusting for this factor provides for a more fair comparison of hospitals’ infections to the predicted.
CLABSI rates are affected by clinical and infection control practices related to the insertion and ongoing care of central lines, risk factors of patients in different types of care locations, and surveillance methods. It is important to consider the overall context of these rates. A low CLABSI rate may reflect greater diligence with infection prevention care practices in central line insertion and maintenance care practices, or may reflect less effective surveillance methods that detect fewer infections. Similarly, a high rate may reflect failure to consistently adhere to all recommended infection prevention care practices, or may reflect more complete and accurate infection surveillance.
What is in this annual report? This document summarizes the key findings including important results, key public health actions and messages for the prevention of CLABSI.
What’s in Table 1? This table presents detailed hospital-specific information that includes observed and predicted numbers of CLABSI, SIRs and their 95% confidence intervals, and symbols indicating hospitals with observed number of infections that were statistically higher, lower, or no different than predicted number of infections.
What’s in Table 2? This table presents average CLABSI rates by patient care location for two time periods: January-December 2013 and January-December 2014, demonstrating the percentage change over the time periods for patient care locations with at least 10 reporting hospitals.
What’s in Table 3? This table lists the statewide average CLABSI rates and CLIP adherence percentages for each patient care location. The distributions of hospital-specific CLABSI rates are presented by key percentiles for patient care locations with at least 10 reporting hospitals. California average CLABSI rates are the peer-based standards against which individual hospital CLABSI rates are compared. Key percentiles provide information on the variability of CLABSI rates reported by hospitals.
What's in Table 4? Similar to consumer product evaluations, this table provides a visual summary of all hospitals in one "snapshot" table. It lists California hospitals ad counties (alphabetically), patient care locations, and symbols identifying those hospital-specific locations where CLABSI rates were statistically higher, lower, or no different than state average rates.
Detailed, hospital-specific CLABSI and CLIP information for each of the patient care locations can be accessed by clicking on either Table 3 or Table 4 above and then clicking on the link for each patient care location. Detailed information for each patient care location includes an alphabetical list of California hospitals (counties); numbers of CLABSI; central line days and CLIP adherence percent; CLABSI rates and their 95% confidence intervals; symbols indicating patient care locations that were statistically higher, lower, or no different from statewide average CLABSI rates; and CLIP adherence percentages for critical care patient care locations.
What’s in Table 46? This table presents hospitals that were excluded from the analysis for the public report, and the reason for exclusion.
What's in Technical Notes? The Technical Notes contain information on the data sources, definitions, risk adjustment methods using CDPH patient care locations, quality assurance and control, statistical methods, and limitations associated with this data release.
For more information on CLABSI prevention, see CLABSI Information