Evaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units.

TitleEvaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units.
Publication TypeJournal Article
Year of Publication2013
AuthorsGaur AH, Miller MR, Gao C, Rosenberg C, Morrell GC, Coffin SE, W Huskins C
JournalInfect Control Hosp Epidemiol
Volume34
Issue7
Pagination663-70
Date Published2013 Jul
ISSN1559-6834
KeywordsCatheter-Related Infections, Catheterization, Central Venous, Child, Hematology, Hospital Departments, Humans, Intensive Care Units, Pediatric, Oncology Service, Hospital, Practice Guidelines as Topic, United States
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%]; [Formula: see text]). 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%]; [Formula: see text]) or to distinguish between primary and secondary bacteremia (65% [2.5%]; [Formula: see text]).

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.

DOI10.1086/671005
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID23739069