In 2015, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) reminded hospitals of the importance of using standardized surveillance definitions to report healthcare-associated infections (HAIs). Concerns remain, however, about how hospitals apply these definitions.
We performed a survey via the Society for Healthcare Epidemiology of America’s Research Network exploring reporting differences for central line-associated bloodstream infection (CLABSI) in U.S. hospitals. Three patient scenarios were presented, and respondents were asked to determine whether the infection was a CLABSI reportable to the CDC’s National Healthcare Safety Network (NHSN), a secondary bloodstream infection, or an infection present on admission. Hospitals were also asked how they adjudicate cases when having a difficult time determining the type of infection, including whether hospitals contact NHSN, ask for physician or committee guidance on HAI determination, or rely solely upon NHSN definitions.
We sent the survey to 88 U.S. hospitals and received a response from 42 (48%). The respondents included 32 infection preventionists (IPs) and 10 non-IPs involved in infection prevention. Respondents correctly classified the case 79.4% of the time (100 out of 126 reviewed scenarios, 3 per respondent), assigned an attribution that would have led to under-reporting 14.3% of the time (18/126), and assigned an attribution that would have led to over-reporting 6.3% of the time (8/126). Respondents from academic medical centers (AMCs) were more likely to accurately report infections with no under reporting (p-value 0.03) than respondents from other types of hospitals. When adjudicating difficult cases, 38/42 (90%) stated that they use the NHSN manual and/or write to NHSN, but physician input (18/42, 43%) or committee input (10/42, 24%) were also common. Of note, 4/42 hospitals (10%) stated that they rely only on physician/committee input.
Our findings suggest variability in the application of NHSN surveillance criteria for CLABSI, with a high reliance on physician or committee review. This appears to result in higher under-reporting by non-AMCs.
C. Adams Barker,
M. Dowling-Schmitt, None