1071. Proposed Methods to Validate Central Line Associated Bloodstream Infections (CLABSIs)
Session: Poster Abstract Session: Surveillance of HAIs: Evaluating National Strategy
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • CLABSI validation donegan_pic.pdf (196.6 kB)
  • Background:

    Medstar Washington Hospital Center is a 940 tertiary care center with 77 ICU beds.

    Our ICUs have mirrored the national trend of decline in CLABSI rates with a decrease from 14.5 infections/1000 catheter days in 2001 to a current rate of 1.5.  CDC NHSN data demonstrate a continued decrease in CLABSIs from most hospitals, with some sustaining a rate of zero for extended periods.  Several papers have addressed problems with inter-rater agreement, variation between surveillance and clinical definitions, and extreme pressure on teams accountable for classification of CLABSIs.   In 2012, the CDC published a CLABSI Validation Guidance and Toolkit.

    Our internal validation includes review by the entire infection prevention team and hospital epidemiologist. When needed cases are also reviewed with clinical staff, and/or NHSN staff before a case is submitted to NHSN.  Our experience has shown that triggers for blood culture collection can be heavily influenced by the patient population treated and local or regional practice standards. Classification of a positive blood culture as primary or secondary is also somewhat subjective, despite NHSN standardization efforts. Validation efforts vary by state and, when performed, show a clear trend toward higher rates.

    Methods:

    To improve validity we have instituted a process of increased review for those cases considered probable CLABSIs, to minimize misclassification in the numerator.  We have improved validity by an additional review of bloodstream infection (BSI) classified as secondary, community, or contaminant.  The rate of secondary BSIs is contrasted with that of CLABSI to assure that there is not a trend of increased secondary as CLABSI decreases.

    Results:

     

    Linear trend lines of quarterly healthcare associated BSI rates since January 2009 confirm that as CLABSI rates decrease (negative slope = -0.0262x) the secondary BSI rates approach level (positive slope = 0.0011x).

    Conclusion:

    The interpretation of a true decrease in CLABSI must be validated internally.   We propose that in addition to the CDC self-validation guidance, institutions should compare trends in CLABSIs and secondary BSIs to assure that there is no systematic error in classification.

    Nancy Donegan, MPH1, Ligia Pic-Aluas, MD1, Mary Jones, RN BSN2, Pamela Farrare-Wilmore, BS, MT, (ASCP)3, Katherine Geiser, RN, BSN1 and Siobhan Moose, RN1, (1)Infection Control, Medstar Washington Hospital Center, Washington, DC, (2)Washington Hospital Center, Washington, DC, (3)Infection Control, Washington Hospital Center, Washington, DC

    Disclosures:

    N. Donegan, None

    L. Pic-Aluas, None

    M. Jones, None

    P. Farrare-Wilmore, None

    K. Geiser, None

    S. Moose, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.