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A systematic review of central-line–associated bloodstream infection (CLABSI) diagnostic reliability and error

Published online by Cambridge University Press:  31 July 2019

Emily N. Larsen Open the ORCID record for Emily N. Larsen [Opens in a new window] ,
Nicole Gavin Open the ORCID record for Nicole Gavin [Opens in a new window] ,
Nicole Marsh ,
Claire M. Rickard Open the ORCID record for Claire M. Rickard [Opens in a new window] ,
Naomi Runnegar Open the ORCID record for Naomi Runnegar [Opens in a new window]  and
Joan Webster Open the ORCID record for Joan Webster [Opens in a new window]
Emily N. Larsen*
Affiliation:
Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia Nursing & Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Nicole Gavin
Affiliation:
Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia Nursing & Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia School of Nursing and Institute of Health and Biomedical Innovation, University of Technology, Brisbane, Queensland, Australia School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
Nicole Marsh
Affiliation:
Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia Nursing & Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
Claire M. Rickard
Affiliation:
Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia Nursing & Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
Naomi Runnegar
Affiliation:
Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Joan Webster
Affiliation:
Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Brisbane, Queensland, Australia Nursing & Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
*
Author for correspondence: Ms Emily Larsen, Nursing and Midwifery Research Centre, Level 2, Bldg 34, Royal Brisbane and Women’s Hospital, Cnr. Bowen Bridge Rd and Butterfield St, Herston QLD 4029 Australia. Email: e.larsen@griffith.edu.au
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Abstract

Objective:

To establish the reliability of the application of National Health and Safety Network (NHSN) central-line–associated bloodstream infection (CLABSI) criteria within established reporting systems internationally.

Design:

Diagnostic-test accuracy systematic review.

Methods:

We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed.

Results:

A systematic search identified 1,259 publications; 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58–0.81) to 0.99 (95% CI, 0.99–1.00) and sensitivity ranged from 0.42 (95% CI, 0.15–0.72) to 0.88 (95% CI, 0.77–0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%–4.4%. The risk of bias was low to moderate in most included studies.

Conclusions:

Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time.

Registration:

Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989; June 7, 2015). https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1100 - 1106
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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