268. Effects of Overnight Attending Intensivist Coverage in Medical Intensive Care Units on Infection-Related Indicators
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • MICU Nightime Intensivist.pdf (521.2 kB)
  • Background: The optimal approach for critical care physician staffing is currently unknown. In June 2013, the medical intensive care units (MICU) in our tertiary care facility moved from a day-time coverage model (utilizing structured multidisciplinary critical care team rounds with night-time "on-call" critical care attending coverage) to providing 24 hour in-house critical care attending coverage. The impact of these critical care attending models on the occurrence of hospital-acquired infections was evaluated with a before-after retrospective analysis.

    Methods: This study included 2 geographically separated MICUs, totaling 29 beds.  Average patient length of stay, length of ventilator duration and device utilization rates for ventilators, central lines and indwelling urinary catheters were compared for the year before and after the change in attending staffing using t tests.  Infection rates for ventilator associated events (VAE), central line association blood stream infection (CLABSI) and catheter associated urinary tract infections (CAUTI) were compared using χ2 (Epi Info 7, CDC).

    Results: There were 2508 admissions in the year before and 2310 admissions in the year after night intensivist coverage was instituted.  Mean length of stay (3.9 days pre-intervention, 4.3 days post, p<0.01) and ventilator utilization (47% pre-intervention, 52% post, p=0.04) both increased after the intervention.  No statistical changes were seen in mean length of ventilation or infection rates (Table 1).

    Conclusion: Institution of nighttime intensivists did not decrease length of exposure to invasive devices or infection rates.

    Table 1: Effect of Addition of Overnight Attending Coverage in Medical Intensive Care Units

     

    Pre- Nighttime Attending

    Post- Nighttime Attending

    p value

     

    6/12 - 5/13

    6/13 - 5/14

     

    Unique Patient Admissions

    2508

    2310

    -

    Mean Length of Stay (Days)

    3.90

    4.28

    0.01

    Unique Ventilation Episodes

    1492

    1363

    --

    Mean Length of Ventilation (Days)

    5.69

    6.42

    0.09

    CLABSI

    4

    6

    -

    CL Days

    7337

    7631

    -

    CLABSI Rate

    0.5

    0.8

    0.56

    Central Line Utilization

    77%

    80%

    0.06

    CAUTI

    28

    28

    -

    UC Days

    7531

    7470

    -

    CAUTI Rate

    3.7

    3.7

    0.98

    Indwelling Urinary Catheter Utilization

    79%

    78%

    0.76

    VAE

    39

    48

    -

    Vent Days

    4498

    4983

    -

    VAE Rate

    8.7

    9.6

    0.63

    Ventilator Utilization

    47%

    52%

    0.04

    Kathleen Mcmullen, MPH, CIC1, Abhaya Trivedi, MD2, Hilary M. Babcock, MD, MPH3 and Marin H. Kollef, MD2, (1)Barnes-Jewish Hospital, St. Louis, MO, (2)Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, (3)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO

    Disclosures:

    K. Mcmullen, None

    A. Trivedi, None

    H. M. Babcock, None

    M. H. Kollef, Theravance: Consultant and Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.