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Evaluating Application of the National Healthcare Safety Network Central Line–Associated Bloodstream Infection Surveillance Definition: A Survey of Pediatric Intensive Care and Hematology/Oncology Units

Aditya H. Gaur MD MSc, Marlene R. Miller MD MSc, Cuilan Gao PhD, Carol Rosenberg ND RN, Gloria C. Morrell RN MSN CIC, Susan E. Coffin MD MPH and W. Charles Huskins MD MSc
Infection Control and Hospital Epidemiology
Vol. 34, No. 7 (July 2013), pp. 663-670
DOI: 10.1086/671005
Stable URL: http://www.jstor.org/stable/10.1086/671005
Page Count: 8
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Evaluating Application of the National Healthcare Safety Network Central Line–Associated Bloodstream Infection Surveillance Definition: A Survey of Pediatric Intensive Care and Hematology/Oncology Units
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Abstract

Objective. To evaluate the application of the National Healthcare Safety Network (NHSN) central line–associated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce CLABSIs; to identify sources of variability in the application of the definition.Design. Online survey using 18 standardized case scenarios. Each described a positive blood culture in a patient and required a yes- or-no answer to the question “Is this a CLABSI?” NHSN staff responses were the reference standard.Setting. Sixty-five US PICUs and PHOUs.Participants. Staff who routinely adjudicate CLABSIs using NHSN definitions.Results. Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios evaluating application of 1 of the 3 criteria (“known pathogen,” 78% [1.7%]; “skin contaminant, >1 year of age,” 76% [SE, 2.5%]; “skin contaminant, ≤1 year of age,” 81% [3.8%]; ). The mean percentage of concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was present or incubating on admission (64% [4.6%]; ) or to distinguish between primary and secondary bacteremia (65% [2.5%]; ).Conclusions. The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary from secondary bloodstream infection are needed.

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