Program Schedule

Evaluation of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI) from the National Healthcare Safety Network (NHSN), 2013

Session: Oral Abstract Session: CLABSI: Surveillance and Prevention
Saturday, October 11, 2014: 8:30 AM
Room: The Pennsylvania Convention Center: 107-AB

Background: In January 2013, the National Healthcare Safety Network (NHSN) introduced a mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) definition into bloodstream infection (BSI) surveillance.  MBI-LCBIs comprise a subset of BSIs that are not likely related to central lines. We describe the epidemiology of MBI-LCBIs and potential impact of removing them from central line associated BSI (CLABSI) rates.

Methods:   MBI-LCBI is defined as a primary BSI due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant (ALHSCT) with gastrointestinal graft-versus-host disease or diarrhea.  We analyzed CLABSI data reported to NHSN from January - June 2013, and described the types of facilities and locations reporting ≥1 MBI-LCBI, and the organisms and clinical characteristics of MBI-LCBI cases reported. We determined CLABSI rates per 1,000 central line days with and without MBI-LCBIs in these locations. 

Results:    Of 10452 CLABSIs reported, 703 (6.7%) met MBI-LCBI criteria.  Among the 172 hospitals reporting ≥ 1 MBI-LCBI, 134 (78%) were general, 21 (12%) were pediatric, and 13 (8%) were oncology.   One or more MBI-LCBI was reported from 279 locations; 158 (58%) were oncology.  Among the cases, 658 (94%) met the neutropenia criterion and 45 (6%) met the ALHSCT criteria.  The most common MBI-LCBI organisms reported were Escherichia coli (23%), Enterococcus faecium (19%) and Klebsiella pneumoniae (8%).  Removal of MBI-LCBI reduced CLABSI rates by 59.2%, ranging from 53.4% to 68.4% by location-type (Figure); for example, pooled mean CLABSI rates in oncology locations went from 2.85 to 1.19 per 1000 central line days after removal of MBI-LCBIs.

Conclusion:  MBI-LCBIs represent a significant proportion of CLABSIs among locations that reported at least 1 MBI-LCBI.  The MBI-LCBI definition addresses a widely-recognized limitation of the CLABSI surveillance definition.  In the future, MBI-LCBIs may be removed from the NHSN CLABSI data used for quality measurement and reported separately. 


Lauren Epstein, MD, MSc1,2, Isaac See, MD1, Shelley S. Magill, MD, PhD1, Jonathan R. Edwards, MStat1 and Nicola D. Thompson, PhD, MSc3, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention, Atlanta, GA


L. Epstein, None

I. See, None

S. S. Magill, None

J. R. Edwards, None

N. D. Thompson, None

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