Evaluation of Hospital-onset Bloodstream Infections in Comparison to Central Line-associated Bloodstream Infections at an Acute, Tertiary Care Hospital

Abstract

Background Central line-associated bloodstream infections (CLABSI) is the current benchmark used in hospital-associated infection (HAI) surveillance, and effective interventions have greatly reduced the incidence in recent years. However, bloodstream infections (BSI) continue to be a major source of morbidity and mortality in hospitals. Therefore, using hospital-onset bloodstream infections (HOBSI) as a benchmark may be a more sensitive indicator of preventable BSI. Our objective is to calculate the rate of HOBSI from all intravenous and intra-arterial catheters, not just those that end in the great vessels near the heart. We will then compare CLABSI and HOBSI rates to evaluate whether HOBSI will better represent the number of preventable BSIs and thus improve HAI surveillance. Methods We conducted a retrospective analysis of all positive blood cultures (n=763) among patients admitted to an acute, tertiary hospital from July 2018 to June 2019. We collected information from electronic medical charts to determine if each blood culture met the HOBSI criteria according to the Centers for Disease Control and Prevention's National Healthcare and Safety Network (NHSN) LabID and BSI definitions. Finally, we calculated the incidence rates per 10,000 patient-days for both definitions and compared them to the CLABSI rate for the same period. Results The incidence rate (IR) of HOBSI using the NHSN LabID definition was 10.25 per 10,000 patient-days. After excluding all HOBSIs that were secondary to other infections using the NHSN BSI definition, we found an IR of 3.77 per 10,000 patient-days. The IR of CLABSI for the same period was 1.84 per 10,000 patient-days. Conclusions After excluding secondary BSIs, the HOBSI rate is still double that of the CLABSI rate. HOBSI surveillance is a more sensitive indicator of BSI than CLABSI, and thus a better target for monitoring effectiveness of interventions. Central line-associated bloodstream infections (CLABSI) is the current benchmark used in hospital-associated infection (HAI) surveillance, and effective interventions have greatly reduced the incidence in recent years. However, bloodstream infections (BSI) continue to be a major source of morbidity and mortality in hospitals. Therefore, using hospital-onset bloodstream infections (HOBSI) as a benchmark may be a more sensitive indicator of preventable BSI. Our objective is to calculate the rate of HOBSI from all intravenous and intra-arterial catheters, not just those that end in the great vessels near the heart. We will then compare CLABSI and HOBSI rates to evaluate whether HOBSI will better represent the number of preventable BSIs and thus improve HAI surveillance. We conducted a retrospective analysis of all positive blood cultures (n=763) among patients admitted to an acute, tertiary hospital from July 2018 to June 2019. We collected information from electronic medical charts to determine if each blood culture met the HOBSI criteria according to the Centers for Disease Control and Prevention's National Healthcare and Safety Network (NHSN) LabID and BSI definitions. Finally, we calculated the incidence rates per 10,000 patient-days for both definitions and compared them to the CLABSI rate for the same period. The incidence rate (IR) of HOBSI using the NHSN LabID definition was 10.25 per 10,000 patient-days. After excluding all HOBSIs that were secondary to other infections using the NHSN BSI definition, we found an IR of 3.77 per 10,000 patient-days. The IR of CLABSI for the same period was 1.84 per 10,000 patient-days. After excluding secondary BSIs, the HOBSI rate is still double that of the CLABSI rate. HOBSI surveillance is a more sensitive indicator of BSI than CLABSI, and thus a better target for monitoring effectiveness of interventions.