Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T10:11:48.424Z Has data issue: false hasContentIssue false
  • English
  • Français

Statewide Validation of Hospital-Reported Central Line–Associated Bloodstream Infections: Oregon, 2009

Published online by Cambridge University Press:  02 January 2015

John Y. Oh ,
Margaret C. Cunningham ,
Zintars G. Beldavs ,
Jennifer Tujo ,
Stephen W. Moore ,
Ann R. Thomas  and
Paul R. Cieslak
John Y. Oh*
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon; and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Present affiliation: Air Force Medical Support Agency, Arlington, Virginia
Margaret C. Cunningham
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon; and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Zintars G. Beldavs
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon; and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Jennifer Tujo
Affiliation:
Communicable Disease Office, Multnomah County Health Department, Portland, Oregon
Stephen W. Moore
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon; and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Ann R. Thomas
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon; and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Paul R. Cieslak*
Affiliation:
Public Health Division, Oregon Health Authority, Portland, Oregon; and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
*
800 NE Oregon Street, Portland, OR 97232 ([email protected])
800 NE Oregon Street, Portland, OR 97232 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Mandatory reporting of healthcare-associated infections is common, but underreporting by hospitals limits meaningful interpretation.

Objective.

To validate mandatory intensive care unit (ICU) central line–associated bloodstream infection (CLABSI) reporting by Oregon hospitals.

Design.

Blinded comparison of ICU CLABSI determination by hospitals and health department–based external reviewers with group adjudication.

Setting.

Forty-four Oregon hospitals required by state law to report ICU CLABSIs.

Participants.

Seventy-six patients with ICU CLABSIs and a systematic sample of 741 other patients with ICU-related bacteremia episodes.

Methods.

External reviewers examined medical records and determined CLABSI status. All cases with CLABSI determinations discordant from hospital reporting were adjudicated through formal discussion with hospital staff, a process novel to validation of CLABSI reporting.

Results.

Hospital representatives and external reviewers agreed on CLABSI status in 782 (96%) of 817 bacteremia episodes (k = 0.77 [95% confidence interval (CI), 0.70-0.84]). Among the 27 episodes identified as CLABSIs by external reviewers but not reported by hospitals, the final status was CLABSI in 16 (59%). The measured sensitivities of hospital ICU CLABSI reporting were 72% (95% CI, 62%-81%) with adjudicated CLABSI determination as the reference standard and 60% (95% CI, 51%-69%) with external review alone as the reference standard (P = .07). Validation increased the statewide ICU CLABSI rate from 1.21 (95% CI, 0.95-1.51) to 1.54 (95% CI, 1.25-1.88) CLABSIs/1,000 central line–days; ICU CLABSI rates increased by more than 1.00 CLABSI/1,000 central line–days in 6 (14%) hospitals.

Conclusions.

Validating hospital CLABSI reporting improves accuracy of hospital-based CLABSI surveillance. Discussing discordant findings improves the quality of validation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 5 , May 2012 , pp. 439 - 445
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Laupland, KB, Lee, H, Gregson, DB, Manns, BJ. Cost of intensive care unit-acquired bloodstream infections. J Hosp Infect 2006; 63(2):124–132.Google Scholar
2.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271(20):1598–1601.Google Scholar
3.Warren, DK, Quadir, WW, Hollenbeak, CS, Elward, AM, Cox, MI, Fraser, VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34(8):2084–2089.Google Scholar
4.Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725–2732.Google Scholar
5.Centers for Disease Control and Prevention. Reduction in central line-associated bloodstream infections among patients in intensive care units-Pennsylvania, April 2001-March 2005. MMWR 2005;54(40):1013–1016.Google Scholar
6.Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;51(RR10):1–26.Google Scholar
7.US Department of Health and Human Services. Action plan to prevent healthcare-associated infections, http://www.hhs.gov/ash/initiatives/hai/actionplan/hhs_hai_action_plan_final _06222009.pdf. Published June 2009. Accessed March 3, 2012.Google Scholar
8.McKibben, L, Horan, TC, Tokars, JI, et al. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2005;26(6):580–587.Google Scholar
9.Fung, CH, Lim, Y-W, Mattke, S, Damberg, C, Shekelle, PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 2008; 148(2):111–123.CrossRefGoogle ScholarPubMed
10.Association for Professionals in Infection Control and Epidemiology. HAI reporting laws and regulations: states that have enacted laws related to reporting of healthcare-associated infections. http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/HAI_map.gif. Accessed March 3, 2012.Google Scholar
11.Office for Oregon Health Policy and Research. Federal vs. state HAI hospital reporting. http://www.oregon.gov/OHA/OHPR/docs/HCAIAC/Reporting/Update_0611/FederalvsStateHAIReporting.pdf/. Accessed August 15, 2011.Google Scholar
12. 74th Oregon Legislative Assembly-2007 Regular Session. House Bill 2524. http://www.oregon.gov/OHPPR/docs/HCAIAC/Reporting/HB_2524.pdf/. Accessed August 15, 2011.Google Scholar
13.Backman, LA, Melchreit, R, Rodriguez, R. Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department. Am J Infect Control 2010;38(10):832–838.Google Scholar
14.McBryde, ES, Brett, J, Russo, PL, Worth, LJ, Bull, AL, Richards, MJ. Validation of statewide surveillance system data on central line-associated bloodstream infection in intensive care units in Australia. Infect Control Hosp Epidemiol 2009;30(11):1045–1049.Google Scholar
15.New York State Department of Health. New York State hospital-acquired infection reporting system: pilot year-2007. http://www.health.state.ny.us/statistics/facilities/hospital/hospital_acquired_infections/. Published July 2008. Accessed August 15, 2011.Google Scholar
16.Office for Oregon Health Policy and Research. Oregon healthcare acquired infections. Salem: Office for Oregon Health Policy and Research; 2010.Google Scholar
17.Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) patient safety component manual. http://www.cdc.gov/nhsn/TOC_PSCManual.html/. Accessed August 15, 2011.Google Scholar
18.Kelly, H, Bull, A, Russo, P, McBryde, ES. Estimating sensitivity and specificity from positive predictive value, negative predictive value and prevalence: application to surveillance systems for hospital-acquired infections. J Hosp Infect 2008;69(2):164–168.CrossRefGoogle ScholarPubMed
19.McKibben, L, Fowler, G, Horan, T, Brennan, PJ. Ensuring rational public reporting systems for health care-associated infections: systematic literature review and evaluation recommendations. Am J Infect Control 2006;34(3):142–149.Google Scholar
20.Perla, RJ, Peden, CJ, Goldmann, D, Lloyd, R. Health care-associated infection reporting: the need for ongoing reliability and validity assessment. Am J Infect Control 2009;37(8): 615–618.Google Scholar
21.Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections-United States, 2001, 2008, and 2009. MMWR 2011;60(8):243–248.Google Scholar
22.Worth, LJ, Brett, J, Bull, AL, McBryde, ES, Russo, PL, Richards, MJ. Impact of revising the National Nosocomial Infection Surveillance System definition for catheter-related bloodstream infection in ICU: reproducibility of the National Healthcare Safety Network case definition in an Australian cohort of infection control professionals. Am J Infect Control 2009;37(8):643–648.Google Scholar
23.Mayer, J, Howell, J, Green, T, et al. Assessing interrater reliability (IRR) of surveillance decisions by infection preventionists (IPs). In: Fifth Decennial International Conference on Healthcare-Associated Infections. Atlanta, GA. March 2010. Abstract 79.Google Scholar
24.Emori, TG, Edwards, JR, Culver, DH, et al. Accuracy of reporting nosocomial infections in intensive-care-unit patients to the National Nosocomial Infections Surveillance System: a pilot study. Infect Control Hosp Epidemiol 1998;19(5):308–316.Google Scholar
25.Sexton, DJ, Chen, LF, Anderson, DJ. Current definition of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31(12):1286–1289.Google Scholar
26.Tokars, JI, Richards, C, Andrus, M, et al. The changing face of surveillance for health care-associated infections. Clin Infect Dis 2004;39(9):1347–1352.Google Scholar