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Elani Kourkouni et al
Table 3. Bland-Altman Percentage Out of Limits of Agreement and ICC Between Estimated and Actual CLABSI Rates by Selected Sampling Permutationsa Sample
BA % of Months With Estimated CLABSI Rate Outside Limits of Agreement
NICUs
Mon–Fri Tue–Wed Wed–Sat Wed–Sun Thu–Sun
4.2 5.6 4.2 2.8 2.8
Sample
Ped-ONCs Mon–Tue Mon–Thu Mon–Fri Tue–Sat Thu–Sat Fri–Sat Fri–Sun
PICUs
Thu–Fri Fri–Sat
8.3 12.5
Adult Units Tue–Fri Tue–Sat Tue–Sun Wed–Sun Thu–Sun
Note. BA, Bland-Altman; NICUs, neonatal intensive care units; Ped-ONCs, pediatric oncology untis; PICUs, pediatric intensive care units. aThat most frequently provided months with PE ≤± 5%.
Table 4. Number of Months (%) With Percentage Error of Estimated CLDs and CLU Ratio ≤ ±5% by Selected Sampling Permutations NICUs
Ped-ONCs CLDs
Sample Mon-Fri
No. (%)
CLU Ratio No. (%)
CLDs Sample No. (%)
CLU Ratio No. (%) Sample
Tue–Wed 28 (39.4) 34 (47.9) Mon–Thu 26 (76.5) 34 (100.0) Wed–Sat 32 (45.1) 43 (60.6) Mon–Fri 26 (76.5) 31 (91.2) Wed–Sun 38 (53.5) 39 (54.9) Tue–Sat 19 (55.9) 33 (97.0) Thu–Sun 36 (50.7) 40 (56.3) Thu–Sat 21 (61.8) 33 (97.0)
Fri–Sat 22 (64.7) 31 (91.2) Fri–Sun 22 (64.7) 32 (94.1)
Note. NICUs, neonatal intensive care units; Ped-ONCs, pediatric oncology untis; PICUs, pediatric intensive care units; CLDs, central-line days; CLU, central-line utilization.
suggest that sampling over 2 days per week provides more accurate estimatedCLDsthansamplingover1day. Ourpro- posal with respect to CLABSI rates is similar. Other studies have also assessed the impact of sampling in CLDs and CLABSI rates.9–12 These studies did not use the same method for the estimation of CLDs; instead, they used the sample’sCLUratio and the total number of actual patient days to estimate CLDs. This method of estimation was not evaluated in our study becauseitismoretime-consumingtorequestthetotal number of patient days each month from the statistics offices of each unit. Despite the different methodology in the estimated CLDs, results of these studies were similar to ours. The impact of sampling on CLABSI rates was minimal. Furthermore, the cutoff of 75 CLDs was further examined, and our findings were similar
to those of Thompson et al.11 The estimated CLDs and CLU ratios were more accurate when the number of actual monthly CLDs was above 75. Our study has some limitations. We examined only the
accuracy of the estimation of CLABSI rates, CLU ratios, and CLDs. There are other metrics within the area of active sur- veillance of CLABSIs. For example, the accuracy of the estima- tion of antibiotic use ratio was not evaluated. Further research is also needed to assess possible factors that might influence the precision of the estimates of CLABSI rates, such as the length of hospital stay and the number of admissions. In addition, more sampling strategies should be considered, such as sampling on random days,samplingover3 days perweek,orsamplingover several months. Our study was limited to the evaluated strategies
PICUs CLDs No. (%)
CLU Ratio No. (%)
Sample 2.9
11.8 5.9 8.8 5.9 8.8 8.8
3.0 7.6 7.6 3.0 4.6
BA % of Months With Estimated CLABSI Rate Outside Limits of Agreement
Adult Units CLDs No. (%)
CLU Ratio No. (%)
35 (49.3) 40 (56.3) Mon–Tue 20 (58.8) 30 (88.2) Thu–Fri 11 (45.8) 12 (50.0) Tue–Fri 52 (78.8) 49 (74.2) Fri–Sat 17 (70.8) 14 (58.3) Tue–Sat 49 (74.2) 48 (72.7) Tue–Sun 46 (69.7) 47 (71.2) Wed–Sun 45 (68.2) 50 (75.8) Thu–Sun 46 (69.7) 56 (84.8)
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