Program Schedule

Evaluation of Manual and Automated Bloodstream Infection Surveillance in Outpatient Dialysis Clinics

Session: Oral Abstract Session: CLABSI: Surveillance and Prevention
Saturday, October 11, 2014: 8:45 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: National Healthcare Safety Network (NHSN) bloodstream infection (BSI) surveillance in outpatient dialysis clinics (ODC), based on positive blood cultures (PBC), is now used by >5,500 ODC.  Traditionally, surveillance relied on manual case finding and data collection, which is time-consuming. A specific challenge is identification of ODC-patient PBC drawn on day 1 or 2 of hospitalization (hospital PBC), because these results is not always readily available to ODC personnel. We compared ODC surveillance results obtained using two methods; manual with dedicated efforts to obtain hospital PBC, and automated based only on ODC electronic health record (EHR) data.

Methods: We compared the results of manual and electronic BSI surveillance, conducted in accordance with  the NHSN protocol  (non-duplicate PBC in outpatient hemodialysis patients), from January to June 2012 among patients at 13 ODC, all part of a single non-profit dialysis organization.  For the manual method, staff from the Tennessee Department of Health identified PBC by reviewing paper and electronic ODC records and records related to care received outside the ODC (e.g., hospital PBC). For the automated method, CDC staff identified PBC from the ODC EHR. BSI rates by vascular access type and the number of BSIs identified via each method were compared and differences investigated.


Manual surveillance identified 68 non-duplicate PBC, of which 24 (all ODC PBC) were also identified via automated surveillance. Rates from manual and automated surveillance were significantly different (table).The major cause of discrepancy was the ODC EHR lacked information on hospital PBC, although most (31 of 44) had ODC EHR documentation of an ICD-9 code consistent with having an infection.

BSI rate per 100 patient-months



Pooled mean rate^












^p-value by for manual vs. automated rate <0.001

Conclusion: In ODC, inclusion of hospital PBC resulted in an important increase in BSI rates. For purposes of quality improvement and public reporting, communication of hospital PBC to ODCs should be improved. Best practices for transmitting these results should be identified.

Nicola D. Thompson, PhD, MSc1, Matthew Wise, PhD1, Ruth Belflower, RN, MPH1, Meredith Kanago, MSPH2, Marion a. Kainer, MBBS, MPH2, Vlad Ladik3, Chris Lovell3 and Priti Patel, MD, MPH1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Tennessee Department of Health, Nashville, TN, (3)Dialysis Clinic, Inc., Nashville, TN


N. D. Thompson, None

M. Wise, None

R. Belflower, None

M. Kanago, None

M. A. Kainer, None

V. Ladik, None

C. Lovell, None

P. Patel, None

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