Trends in validity of central line–associated bloodstream infection surveillance data, New York State, 2007-2010

Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

“…In the final year (2010), the reviewers found 57 missed CLABSIs, with misinterpretation of what defines a CLABSI being the most likely cause of this error (57%), and missed by surveillance (provider did not include CLABSI in the differential) being the second most likely (35%). In conclusion, this study found that audits of hospitals and their patients was an effective method for reducing confusion of CLABSI definition between IP staff and the NHSN (Hazamy et al, 2013). Researchers looking at 44 hospitals in Oregon also found a disparity between the CLABSIs found by hospitals when compared with the researchers applying strict definitions, but they were able to improve accuracy through feedback given to the hospitals (Oh et al, 2012).…”

“…The NHSN is primarily responsible for surveillance of HAIs, whereas the CMS controls hospital reimbursement. These two systems should ideally reach the same findings regarding identification of CLABSI, but studies have shown that this is not always the case (Backman et al, 2010;Hazamy et al, 2013;Moehring et al, 2013). Incongruent interpretation between IP and healthcare providers can distort reported CLABSI rates and hospital reimbursement.…”

“…The process of identifying and reporting CLABSI has been described as complicated and complex due to the everchanging definition of what constitutes a CLABSI and ambiguity about where infections come from, and complex medical patients are at higher risk of contracting a CLABSI (Backman, Melchreit, & Rodriguez, 2010;Hazamy et al, 2013). Hospitals and infection preventionists use the LCBI system to report to the NHSN, while healthcare providers treat patients with CLABSI, who are assigned codes based on the World Health Organization's ICD and used by the CMS and the NHSN.…”

“…The top 10 leading ICD discharge diagnoses are often used by health services researchers and other researchers; yet, there is some evidence that discrepancies exist between classification of CLABSI by clinicians coding using ICD and by infection preventionists applying CDC guidelines. These discrepancies indicate a need for standard definitions to be applied (Backman et al, 2010;Hazamy et al, 2013;Moehring et al, 2013). IPs use strict definitions provided by the CDC.…”

“…To ensure that protocols were followed, a large portion of the hospitals were audited by a group of researchers to examine their medical records of positive blood cultures obtained between 2007 and 2010 (Hazamy et al, 2013). Included in this study were 306 adult ICUs and 30 pediatric ICUs.…”