946. Impact of 2015 NHSN definition changes on ICU CLABSI at a large healthcare system
Session: Oral Abstract Session: HAI: Surveillance and Reporting
Friday, October 28, 2016: 11:30 AM
Room: 388-390

Background: Regulatory agencies in the United States require hospitals use of the National Healthcare Safety Network (NHSN) definitions for central line associated bloodstream infection (CLABSI) surveillance. In 2015, there were several modifications to the NHSN definition of CLABSI. The objective of this study is to quantify the effect of these modifications on reported CLABSI rates.

Methods:  We gathered intensive care unit (ICU) CLABSI data from 8 hospitals within a healthcare system and used data from 2014 as a baseline. Both the 2014 and 2015 NHSN CLABSI definitions were applied to the ICU patients in 2015.  Infection rates were determined using both definitions for the 2015 patients, and compared to 2014 data using chi square analysis (Epi Info 7).

Results: There were 28 CLABSI identified in 2014 baseline data (42,230 central line (cl) days, 0.65 CLABSI per 1000 cl days).  In 2015 there were 52 CLABSI cases under the 2015 NHSN definition (43,599 cl days, 1.19 CLABSI per 1000 cl days), but only 32 cases (0.73 CLABSI per 1000 cl days) when the 2014 definition was used.  Applying the 2014 definition to both years, there was a 12% increase in CLABSI rate (p=0.63), which was not statistically significant. The 2015 definition change resulted in an 83% increase in CLABSI rate (p<0.01). Removal of bronchitis as a cause of secondary bacteremia and the requirement for radiographic evidence of gastrointestinal infection as a cause of secondary bacteremia were the definition changes with the most impact (Table 1).

Table 1: Description of cases that were secondary bacteremias by 2014 definition but CLABSI by 2015 definition

N = 20

Percentage

Matching organism required for secondary bacteremia

     Skin/soft tissue

4

20%

     Myocarditis

1

5%

Radiographic evidence required for secondary bacteremia due to gastrointestinal infection

6

30%

Removal of bronchitis as a site for secondary bacteremia

6

30%

Excluded organisms (required infection to have positive culture with clinically relevant organism)

     Removal of yeast as a cause of CAUTI

2

10%

     Defined list of endocarditis organisms

1

5%

Conclusion:  The changes to the CLABSI definition in 2015 lead to a significant perceived 83% increase in CLABSI. The impact that this will have on national benchmark data for hospitals is unknown.

Lydia Grimes, MSN, RN, BA, CIC1, Kathleen M. Mcmullen, MPH, CIC2, Carole Leone, RN, MSN, CIC3, Ashleigh Goris, MPH, BSN, RN, CIC4, Cassandra Mueller, MSN, RN5, Cathy Carroll, PhD, MA, MBA6, Myra Anderson, MT(ASCP)7, Jennifer Zimmerman, BSN, RN8, Amber Conrad, RN9, David K. Warren, MD, MPH, FIDSA, FSHEA10 and Hilary M. Babcock, MD, MPH10, (1)Infection Prevention, Barnes Jewish Hospital, St. Louis, MO, (2)Infection Prevention and Occupational Health, Christian Hospital and Northwest HealthCare, St. Louis, MO, (3)BJC Healthcare, St. Louis, MO, (4)Infection Prevention, Missouri Baptist Medical Center, St. Louis, MO, (5)Infection Prevention, Boone Hospital Center, Columbia, MO, (6)Infection Prevention, Barnes Jewish West County Hospital, Creve Coeur, MO, (7)Infection Prevention, Alton Memorial Hospital, Alton, IL, (8)Missouri Baptist Sullivan Hospital, Sullivan, MO, (9)Infection Prevention, Parkland Health Center, Farmington, MO, (10)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO

Disclosures:

L. Grimes, None

K. M. Mcmullen, None

C. Leone, None

A. Goris, None

C. Mueller, None

C. Carroll, None

M. Anderson, None

J. Zimmerman, None

A. Conrad, None

D. K. Warren, None

H. M. Babcock, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.