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Evaluating Application of the National Healthcare Safety NetworkCentral Line—Associated Bloodstream Infection Surveillance Definition: A Survey of Pediatric Intensive Care and Hematology/Oncology Units

Published online by Cambridge University Press:  02 January 2015

Aditya H. Gaur ,
Marlene R. Miller ,
Cuilan Gao ,
Carol Rosenberg ,
Gloria C. Morrell ,
Susan E. Coffin  and
W. Charles Huskins
Aditya H. Gaur*
Affiliation:
St. Jude Children's Research Hospital, Memphis, Tennessee
Marlene R. Miller
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland Children's Hospital Association, Alexandria, Virginia
Cuilan Gao
Affiliation:
St. Jude Children's Research Hospital, Memphis, Tennessee
Carol Rosenberg
Affiliation:
Children's Hospital Association, Alexandria, Virginia
Gloria C. Morrell
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Susan E. Coffin
Affiliation:
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
W. Charles Huskins
Affiliation:
Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
*
Department of Infectious Diseases, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105 (aditya.gaur@stjude.org)
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Abstract

Objective.

To evaluate the application of the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce CLABSIs; to identify sources of variability in the application of the definition.

Design.

Online survey using 18 standardized case scenarios. Each described a positive blood culture in a patient and required a yes-or-no answer to the question “Is this a CLABSI?” NHSN staff responses were the reference standard.

Setting.

Sixty-five US PICUs and PHOUs.

Participants.

Staff who routinely adjudicate CLABSIs using NHSN definitions.

Results.

Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios evaluating application of 1 of the 3 criteria (“known pathogen,” 78% [1.7%]; “skin contaminant, >1 year of age,” 76% [SE, 2.5%]; “skin contaminant, ≤1 year of age,” 81% [3.8%]; P = .3 ). The mean percentage of concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was present or incubating on admission (64% [4.6%]; P = .017) or to distinguish between primary and secondary bacteremia (65% [2.5%]; P = .021).

Conclusions.

The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary from secondary bloodstream infection are needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 7 , July 2013 , pp. 663 - 670
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.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(26):2725–2732.CrossRefGoogle ScholarPubMed
2.Pronovost, PJ, Goeschel, CA, Wachter, RM. The wisdom and justice of not paying for “preventable complications.” JAMA 2008;299(18):2197–2199.CrossRefGoogle Scholar
3.Srinivasan, A, Craig, M, Cardo, D. The power of policy change, federal collaboration, and state coordination in healthcare-associated infection prevention. Clin Infect Dis 2012;55(3):426–431.CrossRefGoogle ScholarPubMed
4. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. CDC website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Updated January 1, 2013. Accessed February 21, 2013.Google Scholar
5.Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011;39(10)798–816.CrossRefGoogle ScholarPubMed
6.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–332.CrossRefGoogle ScholarPubMed
7.Jeffries, HE, Mason, W, Brewer, M, et al. Prevention of central venous catheter–associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 2009;30(7):645–651.CrossRefGoogle ScholarPubMed
8.Miller, MR, Griswold, M, Harris, JM II, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010;125(2):206–213.CrossRefGoogle ScholarPubMed
9.Miller, MR, Niedner, MF, Huskins, WC, et al. Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics 2011;128(5):e1077–e1083.CrossRefGoogle ScholarPubMed
10.Schulman, J, Stricof, R, Stevens, TP, et al. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127(3):436–444.CrossRefGoogle ScholarPubMed
11.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(3):316–320.CrossRefGoogle ScholarPubMed
12.Backman, LA, Melchreit, R, Rodriguez, R. Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department. Am J Infect Control 2010;38(10):832–838.CrossRefGoogle ScholarPubMed
13.Emori, TG, Edwards, JR, Culver, DH, et al. Accuracy of reporting nosocomial infections in intensive-care-unit patients to the National Nosocomial Infections Surveillance System: a pilot study. Infect Control Hosp Epidemiol 1998;19(5):308–316.CrossRefGoogle Scholar
14.Fridkin, SK, Olmsted, RN. Meaningful measure of performance: a foundation built on valid, reproducible findings from surveillance of health care-associated infections. Am J Infect Control 2011;39(2):87–90.CrossRefGoogle ScholarPubMed
15.Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304(18):2035–2041.CrossRefGoogle ScholarPubMed
16.Mayer, J, Greene, T, Howell, J, et al. Agreement in classifying bloodstream infections among multiple reviewers conducting surveillance. Clin Infect Dis 2012;55(3):364–370.CrossRefGoogle ScholarPubMed
17.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:(11)1045–1049.CrossRefGoogle ScholarPubMed
18.Niedner, MF, 2008 National Association of Children's Hospitals and Related Institutions Pediatric Intensive Care Unit Patient Care FOCUS Group. The harder you look, the more you find: catheter-associated bloodstream infection surveillance variability. Am J Infect Control 2010;38(8):585–595.CrossRefGoogle Scholar
19.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(12):1286–1289.CrossRefGoogle ScholarPubMed
20.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(8):643–648.CrossRefGoogle Scholar
21. Protection of human subjects, 45 CFR §46.101(b)(2).Google Scholar
22. The R Project for Statistical Computing, www.r-project.org/. Accessed February 21, 2013.Google Scholar
23. National Healthcare Safety Network (NHSN) training. CDC website, http://www.cdc.gov/nhsn/training/. Updated September 28, 2012. Accessed February 21, 2013.Google Scholar
24.Wright, M-O, Hebden, JN, Allen-Bridson, K, Morrell, GC, Horan, TC. An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: a supplement of new case studies. Am J Infect Control 2012;40(5, suppl):S32–S40.CrossRefGoogle Scholar
25.See, I, Iwamoto, M, Allen-Bridson, K, et al. A New National Healthcare Safety Network definition to identify bloodstream infections related to mucosal barrier injury: results from a multicenter field test. ID Week 2012 website. https://idsa.confex.com/idsa/2012/webprogram/Paper38295.html. Accessed February 21, 2013.Google Scholar
26. Highlighted NHSN January 2013 patient safety component (PSC) manual updates. CDC website, http://www.cdc.gov/nhsn/PDFs/Newsletters/January-2013-PSC-Updates.pdf. Updated January 1, 2013. Accessed February 21, 2013.Google Scholar
27.Beekmann, SE, Diekema, DJ, Huskins, WC, et al. Diagnosing and reporting of central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2012;33(9):875–882.CrossRefGoogle ScholarPubMed
28. NHSN. Newsletters. CDC website, http://www.cdc.gov/nhsn/newletters.html. Updated January 31, 2013. Accessed February 21, 2013.Google Scholar