From those who brought you “getting to zero”

Here’s a comment that has received an unusually robust response on the Emerging Infections Network:

My hospital system plans to do blood cultures on all patients who are admitted with a central line in place (decision not yet final, but momentum is great). Such cultures would prevent mis-labeling of community-acquired infections as hospital-acquired, if infection actually happened to be present on admission and was not clinically suspected. This would allow upgrade of DRGs, to increase reimbursement, and would prevent a CLABSI from being labeled wrongly as hospital acquired. Our state has mandatory reporting and comparison of CLABSI for all hospitals and there is great pressure to reduce rates. I have great reservations about this practice, having seen this done before when blood contaminants stalled the entire purpose of the admission, adding to antibiotic use and length of stay. Does anyone else have opinions or experience with this practice?

So just to be clear: as a result of pressure to get their publicly reported rates of CLABSI to zero (and to maximize reimbursement), this hospital plans to obtain admission blood cultures on every patient with a central venous catheter. Not only will these non-indicated cultures drive up healthcare costs, they will result in untold days of unnecessary antibiotic use (for the blood culture contaminants that will greatly outnumber true pathogens), increase pressure for antimicrobial resistance, prolong hospital stays, and could result in potentially lethal adverse effects (drug reactions, C. difficile, etc.).

Happy Monday!