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Probabilistic Measurement of Central Line–Associated Bloodstream Infections

  • Bala Hota (a1), Paul Malpiedi (a2), Scott K. Fridkin (a2), John Martin (a3) and William Trick (a4)...



To develop a probabilistic method for measuring central line–associated bloodstream infection (CLABSI) rates that reduces the variability associated with traditional, manual methods of applying CLABSI surveillance definitions.


Multicenter retrospective cohort study of bacteremia episodes among patients hospitalized in adult patient-care units; the study evaluated presence of CLABSI.


Hospitals that used SafetySurveillor software system (Premier) and who also reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).


Patients were identified from a stratified sample from all eligible blood culture isolates from all eligible hospital units to generate a final set with an equal distribution (ie, 20%) from each unit type. Units were divided a priori into 5 major groups: medical intensive care unit, surgical intensive care unit, medical-surgical intensive care unit, hematology unit, or general medical wards.


Episodes were reviewed by 2 experts, and a selection of discordant reviews were re-reviewed. Data were joined with NHSN data for hospitals for in-plan months. A predictive model was created; model performance was assessed using the c statistic in a validation set and comparison with NHSN reported rates for in-plan months.


A final model was created with predictors of CLABSI. The c statistic for the final model was 0.75 (0.68–0.80). Rates from regression modeling correlated better with expert review than NHSN-reported rates.


The use of a regression model based on the clinical characteristics of the bacteremia outperformed traditional infection preventionist surveillance compared with an expert-derived reference standard.

Infect. Control Hosp. Epidemiol. 2016;37(2):149–155


Corresponding author

Address correspondence to Bala Hota, MD, MPH, Internal Medicine, Rush University Medical Center, Office 364, 1700 W Van Buren St, Chicago, IL 60612 (


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1. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101114.
2. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
3. McKibben, L, Horan, TC, Tokars, JI, et al. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2005;26:580587.
4. Pronovost, PJ, Miller, M, Wachter, RM. The GAAP in quality measurement and reporting. JAMA 2007;298:18001802.
5. Passaretti, CL, Barclay, P, Pronovost, P, Perl, TM. Public reporting of health care-associated infections (HAIs): approach to choosing HAI measures. Infect Control Hosp Epidemiol 2011;32:768774.
6. Panzer, RJ, Gitomer, RS, Greene, WH, Webster, PR, Landry, KR, Riccobono, CA. Increasing demands for quality measurement. JAMA 2013;310:19711980.
7. Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304:20352041.
8. Mayer, J, Greene, T, Howell, J, et al. Agreement in classifying bloodstream infections among multiple reviewers conducting surveillance. Clin Infect Dis 2012;55:364370.
9. McBryde, ES, Brett, J, Russo, PL, Worth, LJ, Bull, AL, Richards, MJ. Validation of statewide surveillance system data on central line-associated bloodstream infection in intensive care units in Australia. Infect Control Hosp Epidemiol 2009;30:10451049.
10. Worth, LJ, Brett, J, Bull, AL, McBryde, ES, Russo, PL, Richards, MJ. Impact of revising the National Nosocomial Infection Surveillance System definition for catheter-related bloodstream infection in ICU: reproducibility of the National Healthcare Safety Network case definition in an Australian cohort of infection control professionals. Am J Infect Control 2009;37:643648.
11. DiGiorgio, MJ, Fatica, C, Oden, M, et al. Development of a modified surveillance definition of central line–associated bloodstream infections for patients with hematologic malignancies. Infect Control Hosp Epidemiol 2012;33:865868.
12. Gaur, AH, Bundy, DG, Gao, C, et al. Surveillance of hospital-acquired central line–associated bloodstream infections in pediatric hematology-oncology patients: lessons learned, challenges ahead. Infect Control Hosp Epidemiol 2013;34:316320.
13. Steinberg, JP, Robichaux, C, Tejedor, SC, Reyes, MD, Jacob, JT. Distribution of pathogens in central line–associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013;34:171175.
14. Sexton, DJ, Chen, LF, Moehring, R, Thacker, PA, Anderson, DJ. Casablanca redux: we are shocked that public reporting of rates of central line–associated bloodstream infections are inaccurate. Infect Control Hosp Epidemiol 2012;33:932935.
15. Rakow, T, Wright, RJ, Spiegelhalter, DJ, Bull, C. The pros and cons of funnel plots as an aid to risk communication and patient decision making. Br J Psychol 2015;106:327348.
16. Schulman, J, Spiegelhalter, DJ, Parry, G. How to interpret your dot: decoding the message of clinical performance indicators. J Perinatol 2008;28:588596.
17. Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection). CDC website. Published January 2015. Updated April 2015. Accessed August 21, 2015.
18. Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31:12861289.
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