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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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