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The Burden of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection among Hematology, Oncology, and Stem Cell Transplant Patients

Published online by Cambridge University Press:  18 December 2014

Kristen E. Metzger ,
Yvonne Rucker ,
Mary Callaghan ,
Michelle Churchill ,
Borko D. Jovanovic ,
Teresa R. Zembower  and
Maureen K. Bolon
Kristen E. Metzger*
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, Illinois
Yvonne Rucker
Affiliation:
Department of Nursing, Northwestern Memorial Hospital, Chicago, Illinois
Mary Callaghan
Affiliation:
Department of Nursing, Northwestern Memorial Hospital, Chicago, Illinois
Michelle Churchill
Affiliation:
Department of Nursing, Northwestern Memorial Hospital, Chicago, Illinois
Borko D. Jovanovic
Affiliation:
Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Teresa R. Zembower
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, Illinois Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Maureen K. Bolon
Affiliation:
Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, Illinois Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
*
Address correspondence to Kristen E. Metzger, MPH, CIC, Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, 645 N. Michigan Ave., Suite 900, Chicago, IL 60611 (kmetzger@nm.org).
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Abstract

Objective

To evaluate the impact and burden of the new National Healthcare Safety Network surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), in hematology, oncology, and stem cell transplant populations.

Design

Retrospective cohort study.

Setting

Two hematology, oncology, and stem cell transplant units at a large academic medical center.

Methods

Central line–associated bloodstream infections (CLABSIs) identified during a 14-month period were reviewed and classified as MBI-LCBI or non-MBI-LCBI (MBI-LCBI criteria not met). During this period, interventions to improve central line maintenance were implemented. Characteristics of patients with MBI-LCBI and non-MBI-LCBI were compared. Total CLABSI, MBI-LCBI, and non-MBI-LCBI rates were compared between baseline and postintervention phases of the study period.

Results

Among 66 total CLABSI cases, 47 (71%) met MBI-LCBI criteria. Patients with MBI-LCBI and non-MBI-LCBI were similar in regard to most clinical and demographic characteristics. Between the baseline and postintervention study periods, the overall CLABSI rate decreased from 3.37 to 3.21 infections per 1,000 line-days (incidence rate ratio, 0.95; 4.7% reduction, P=.84), the MBI-LCBI rate increased from 2.08 to 2.61 infections per 1,000 line-days (incidence rate ratio, 1.25; 25.3% increase, P=.44), and the non-MBI-LCBI rate decreased from 1.29 to 0.60 infections per 1,000 line-days (incidence rate ratio, 0.47; 53.3% reduction, P=.12).

Conclusions

Most CLABSIs identified among hematology, oncology, and stem cell transplant patients met MBI-LCBI criteria, and CLABSI prevention efforts did not reduce these infections. Further review of the MBI-LCBI definition and impact is necessary to direct future definition changes and reporting mandates.

Infect Control Hosp Epidemiol 2014;00(0): 1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 2 , February 2015 , pp. 119 - 124
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Present affiliation: Palliative Care Division, NorthShore University Health System, Glenview, Illinois [M. Churchill].

Presented in part: Association of Professionals in Infection Control and Epidemiology Annual Conference; Anaheim, CA; June 7, 2014 (Abstract 413).

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