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The Impact of Hospital Practice on Central Venous Catheter—Associated Bloodstream Infection Rates at the Patient and Unit Level: A Multicenter Study

Objective : Little is known about factors driving variation in bloodstream infection (BSI) rates between institutions. The objectives of this study are to (1) identify patient, process of care, and hospital factors that influence intensive care unit (ICU)-level BSI rates and (2) compare those factors to individual risk factors identified in a cohort analysis. Design: In this multicenter prospective observational study, the authors measured the process of care for 2970 randomly sampled central venous catheter insertions over 13 months. Setting: Medical, surgical, and medical/surgical ICUs of 37 domestic and 13 international hospitals. Results: Significant correlates of unit-level BSI rates were percentage of female patients, patients on dialysis, ICU bed size, percentage of practitioners with low numbers of previous insertions, and percentage inserted by nurses. Patient-level analysis identified gender, age, posttransplant, postsurgery, and use of the line for parenteral nutrition. Conclusions: Factors that influence unit-to-unit variation may differ from factors identified in studies of individual patient risk. (Am J Med Qual 2008;23:24-38)