Evaluation of the Reporting Validity of Central Line–Associated Bloodstream Infection Data to a Provincial Surveillance Program

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BACKGROUND Following implementation of bundled practices in 2009 in Quebec and Canadian intensive care units (ICUs), we describe CLABSI epidemiology during the last 8 years in the province of Québec (Canada) and compare rates with Canadian and American benchmarks. METHODS CLABSI incidence rates (IRs) and central venous catheter utilization ratios (CVCURs) by year and ICU type were calculated using 2007-2014 data from the Surveillance Provinciale des Infections Nosocomiales (SPIN) program. Using American and Canadian surveillance data, we compared SPIN IRs to rates in other jurisdictions using standardized incidence ratios (SIRs). RESULTS In total, 1,355 lab-confirmed CLABSIs over 911,205 central venous catheter days (CVC days) were recorded. The overall pooled incidence rate (IR) was 1.49 cases per 1,000 CVC days. IRs for adult teaching ICUs, nonteaching ICUs, neonatal ICUs (NICUs), and pediatric ICUs (PICUs) were 1.04, 0.91, 4.20, and 2.15 cases per 1,000 CVC days, respectively. Using fixed SPIN 2007-2009 benchmarks, CLABSI rates had decreased significantly in all ICUs except for PICUs by 2014. Rates declined by 55% in adult teaching ICUs, 52% in adult nonteaching ICUs, and 38% in NICUs. Using dynamic American and Canadian CLABSI rates as benchmarks, SPIN adult teaching ICU rates were significantly lower and adult nonteaching ICUs had lower or comparable rates, whereas NICU and PICU rates were higher. CONCLUSION Québec ICU CLABSI surveillance shows declining CLABSI rates in adult ICUs. The absence of a decrease in CLABSI rate in NICUs and PICUs highlights the need for continued surveillance and analysis of factors contributing to higher rates in these populations. Infect Control Hosp Epidemiol 2016;1-9.

Section: Spin Surveillance Networkmentioning

confidence: 99%

Central-Line–Associated Bloodstream Infections in Québec Intensive Care Units: Results from the Provincial Healthcare-Associated Infections Surveillance Program (SPIN)

Fortin

Tremblay

et al. 2016

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“…Moreover, although our study relied on local adjudication of CLABSI diagnosis, a recent validation study showed a sensitivity and specificity of the SPIN-BACC surveillance system of 88% (95% confidence interval [CI], 77%-95%) and 92% (95% CI, 80%-98%), respectively. 33 Another limitation is the varied case mix of patients admitted to participating NICUs; although all units are NICU level II/III, the distribution of premature infants and intra-abdominal pathology, for example, vary according to the hospital's mission. Means to allow for a finer stratification based on case mix are needed.…”

Section: Microbiologymentioning

confidence: 99%

Central Line–Associated Bloodstream Infection in Neonatal Intensive Care Units

Blanchard

Fortin

Rocher³

et al. 2013

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“…22 Most studies were conducted in the United States of America (n=5) using NHSN Reporting; 17,18,[21][22][23] the remaining studies were conducted in Australia, 24 Canada, 25 Korea, 26 and Spain, 27 each with their own central reporting systems replicating NHSN/CDC criterion. Four studies included a consecutive series of patients; 17,18,21,26 the remaining studies included a random sample, either stratified 22,25,27 or unstratified/unclear. 23,24 Table 1 outlines characteristics of each included study, as well as sensitivity, specificity, PPV and NPV, incidence and accuracy results.…”

Section: Resultsmentioning

confidence: 99%

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

Larsen

Gavin

Marsh

et al. 2019

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