A systematic review of central-line–associated bloodstream infection (CLABSI) diagnostic reliability and error

Abstract

Objective:To establish the reliability of the application of National Health and Safety Network (NHSN) central-line–associated bloodstream infection (CLABSI) criteria within established reporting systems internationally.Design:Diagnostic-test accuracy systematic review.Methods:We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed.Results:A systematic search identified 1,259 publications; 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58–0.81) to 0.99 (95% CI, 0.99–1.00) and sensitivity ranged from 0.42 (95% CI, 0.15–0.72) to 0.88 (95% CI, 0.77–0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%–4.4%. The risk of bias was low to moderate in most included studies.Conclusions:Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time.Registration:Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989; June 7, 2015). https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989

Epidemiology of healthcare-associated infection reported from a hospital-wide incidence study: considerations for infection prevention and control planning

“…Whereas the incidence of BSI may appear high within this study, BSI incidence reported here includes central line-associated bloodstream infection (CLABSI) along with bloodstream infections associated with other primary infections and those with undefined sources that meet the ECDC case definitions. A recent review has also indicated that CLABSI is likely underreported nationally when compared to expert review using consistently applied case definitions [42]. The specialties with the highest recorded incidence per 100,000 bed-days were ICU, renal medicine, and cardiothoracic surgery (Figure 1).…”

Deep Learning Model to Predict Serious Infection Among Children With Central Venous Lines

“…While specific definitions for entities such as CLABSI and sepsis exist in pediatrics, they often have inadequate sensitivity for clinically important infections and may be difficult to generalize across electronic medical record (EMR) platforms (7,8). Presumed serious infection (PSI), which is used in both adult and pediatric sepsis surveillance systems, is defined as a blood culture being obtained (regardless of the result) followed by new antimicrobial agents started within 2 days of the blood culture (i.e., agents that were not being administered prior to the blood culture) that are administered for at least 4 consecutive days or until time of death or transfer to another hospital (9)(10)(11).…”

Sustainable neonatal CLABSI surveillance: consensus towards new criteria in the Netherlands

“…infections (HAI) are a main focus of infection prevention and control initiatives and are considered to be an important quality indicator in neonatal care [2][3][4]. Surveillance of CLABSI is essential to evaluate the success of preventive interventions and to measure trends over time [5][6][7]. Standardised CLABSI monitoring enables intra-and interfacility incidence rate comparisons which contributes to practice improvement [7,8].…”

“…Surveillance of CLABSI is essential to evaluate the success of preventive interventions and to measure trends over time [5][6][7]. Standardised CLABSI monitoring enables intra-and interfacility incidence rate comparisons which contributes to practice improvement [7,8]. National registration systems of CLABSI have shown to be beneficial in this matter [9].…”

“…Elements included in existing surveillance criteria (SC) range from simple definitions based on mainly laboratory data to detailed clinical CLABSI definitions specified to the neonatal population [11]. Case definitions for infection surveillance established by the US National Healthcare Surveillance Network (NHSN) in partnership with the Centers for Disease Control and Prevention (CDC) have been adopted in whole or modified forms by numerous reporting agencies internationally [7]. However, the CDC CLABSI criteria are available for patients ≤ 1 year of age and are not specifically developed for use in newborns with a lower body weight and corresponding lower circulating blood volumes [12].…”