Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line–Associated Bloodstream Infections in Adult Hospitalized Patients

Abstract

Background: Parenteral nutrition is associated with increased central line–associated bloodstream infections (CLABSIs). Electronic databases are important for identifying independent risk factors for prevention strategies. Our aims were to evaluate the utility of using electronic data sources to identify risk factors for CLABSIs, including parenteral nutrition (PN), and to assess the association between CLABSI and PN administration. Methods: Data were obtained for all discharges of adult patients in whom a central line was inserted between September 1, 2007, and December 31, 2008, in a large, academically affiliated hospital in New York City. CLABSI was defined electronically using a modified definition from the Centers for Disease Control and Prevention. A manual chart review was also undertaken to assess validity/reliability of the electronic database and gather additional information. Risk factors for CLABSI were examined using logistic regression. Results: Among 4840 patients, there were 220 CLABSIs, an incidence of 5.4 CLABSIs per 1000 central line days. Risk factors included PN (odds ratio [OR], 4.33; 95% confidence interval [CI], 2.50–7.48), intensive care unit stay (OR, 2.26; 95% CI, 1.58–3.23), renal disease (OR, 2.79; 95% CI, 2.00–3.88), and immunodeficiency (OR, 2.26; 95% CI, 1.70–3.00). Diabetes mellitus was associated with reduced CLABSI rates (OR, 0.63; 95% CI, 0.45–0.88). Conclusions: The utility of electronic medical records for determining risk factors is limited by such things as free-text data entry. Using a hybrid between fully electronic and manual chart review, reliable data were obtained. PN is associated with a high risk for CLABSI in a population highly selected for indications for PN.