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Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection: Results from a Field Test of a New National Healthcare Safety Network Definition

Published online by Cambridge University Press:  02 January 2015

Isaac See ,
Martha Iwamoto ,
Kathy Allen-Bridson ,
Teresa Horan ,
Shelley S. Magill  and
Nicola D. Thompson
Isaac See*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Martha Iwamoto
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Kathy Allen-Bridson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Teresa Horan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Shelley S. Magill
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Nicola D. Thompson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Road NE A-24, Atlanta, GA 30333 ([email protected])
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Abstract

Objective.

To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).

Design.

Multicenter field test.

Setting.

Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance.

Methods.

Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported.

Results.

Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; k= 0.82). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing.

Conclusions.

Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 8 , August 2013 , pp. 769 - 776
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Pyrek, KM. Public reporting of infections and the CLABSI mandate. Infect Control Today. January 17, 2011. http.//www.infectioncontroltoday.com/articles/2011/01/public-reporting-of-infections-and-the-clabsi-mandate.aspx. Accessed January 9, 2013.Google Scholar
2.Fraser, TG, Gordon, SM. CLABSI rates in immunocompromised patients: a valuable patient centered outcome? Clin Infect Dis 2011;52(12):1446–1450.Google Scholar
3.Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31(12):1286–1289.Google Scholar
4.Worth, LJ, Slavin, MA, Brown, GV, Black, J. Catheter-related bloodstream infections in hematology: time for standardized surveillance? Cancer 2007;109(7):1215–1226.Google Scholar
5.Pehar, M, Ristaino, P, Budd, AP, et al. Application of the National Healthcare Safety Network (NHSN) central line associated bloodstream infection (CLA-BSI) definition to oncology patients: impact in the trenches. In: Program and Abstracts of the Fifth Decennial International Conference on Healthcare-Associated infections. March 18-22, 2010; Atlanta, GA. Abstract 660.Google Scholar
6.DiGiorgio, MJ, Fatica, C, Oden, M, et al.Development of a modified surveillance definition of central line-associated bloodstream infections for patients with hematologic malignancies. Infect Control Hosp Epidemiol 2012;33(9):865–868.Google Scholar
7.Freeman, JT, Elinder-Camburn, A, McClymont, C, et al.Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013;34(1):89–92.CrossRefGoogle ScholarPubMed
8.Steinberg, JP, Robichaux, C, Tejedor, SC, Reyes, MD, Jacob, JT. Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol 2013;34(2):171–175.Google Scholar
9.Blijlevens, NM, Donnelly, JP, De Pauw, BE. Mucosal barrier injury biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 2000;25(12):1269–1278.Google Scholar
10.Central Line—Associated Bloodstream Infection (CLABSI) Event. National Healthcare Safety Network website, http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed January 9, 2013.Google Scholar
11.CDC Locations and Descriptions—Patient Safety Component Manual. National Healthcare Safety Network website, http://www.cdc.gov/nhsn/PDFs/pscManual/15LocationsDescriptions_current.pdf. Accessed January 9, 2013.Google Scholar
12.Przepiorka, D, Weisdorf, D, Martin, P, et al.Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995;15:825–858.Google Scholar
13.Tomblyn, M, Chiller, T, Einsele, H, et al.Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009;15(10):1143–1238.Google Scholar
14.Freifeld, AG, Bow, EJ, Sepkowitz, KA, et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52(4):e56–e93.CrossRefGoogle ScholarPubMed