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. 2012 Dec;33(12):1213-8.
doi: 10.1086/668422. Epub 2012 Oct 19.

On the role of length of stay in healthcare-associated bloodstream infection

Christie Y Jeon  1 , Matthew Neidell, Haomiao Jia, Matt Sinisi, Elaine Larson
Affiliations

On the role of length of stay in healthcare-associated bloodstream infection

Christie Y Jeon et al. Infect Control Hosp Epidemiol. 2012 Dec.

Abstract

Design: We conducted a retrospective cohort study to examine the role played by length of hospital stay in the risk of healthcare-associated bloodstream infection (BSI), independent of demographic and clinical risk factors for BSI.

Patients: We employed data from 113,893 admissions from inpatients discharged between 2006 and 2008.

Setting: Large tertiary healthcare center in New York City.

Methods: We estimated the crude and adjusted hazard of BSI by conducting logistic regression using a person-day data structure. The covariates included in the fully adjusted model included age, sex, Charlson score of comorbidity, renal failure, and malignancy as static variables and central venous catheterization, mechanical ventilation, and intensive care unit stay as time-varying variables.

Results: In the crude model, we observed a nonlinear increasing hazard of BSI with increasing hospital stay. This trend was reduced to a constant hazard when fully adjusted for demographic and clinical risk factors for BSI.

Conclusion: The association between longer length of hospital stay and increased risk of infection can largely be explained by the increased duration of stay among those who have underlying morbidity and require invasive procedures. We should take caution in attributing the association between length of stay and BSI to a direct negative impact of the healthcare environment.

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Conflict of interest statement

Potential conflicts of interest. All authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.

Figures

FIGURE 1
FIGURE 1
Plot of the unadjusted hazard of bloodstream infection (BSI) and the changing distribution of persons with renal failure or central venous catheter over time. CI, confidence interval.
FIGURE 2
FIGURE 2
Plot of the hazard of bloodstream infection estimated from models with sequential adjustment for risk factors for bloodstream infection. ICU, intensive care unit.
See this image and copyright information in PMC

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