Selective National Healthcare Safety Network Central Line-Associated Bloodstream Infection Validation in State Health Department, Jan – June 2018

Abstract

Background Accurate reporting to the National Healthcare Safety Network (NHSN) is critical in providing actionable surveillance data to inform infection prevention (IP) programs. The state health department (SHD) validated Central Line-Associated Bloodstream Infections (CLABSI) to assess data accuracy and identify common reporting errors. Methods Utilizing the NHSN external validation toolkit, the SHD validated 21 facilities based on data reported from Intensive Care Units (ICU) and Medical, Surgical, and Medical/Surgical Ward locations during January to June 2018. Nine facilities were selected for both ICU and Ward locations, 6 for ICU only and 6 for Ward only. For each facility, up to 20 reported NHSN CLABSI events and up to 40 unreported or candidate events were reviewed. Patient medical records were reviewed to determine if the selected blood culture met CLABSI event criteria. Results The SHD reviewed a total of 1112 medical records. The SHD identified 120 reportable CLABSI events; of these, 7/120 (6%) were reported with errors and 10/120 (8%) were not reported at all. Additionally, the SHD found two reported events that were deemed Secondary Bloodstream Infections (BSI); therefore, did not meet primary CLABSI criteria and were subsequently over-reported. The overall sensitivity was 92% and specificity was 99.8%. Facility specific sensitivities ranged from 71% to 100%. Conclusions The majority of unreported CLABSI events were due to misattribution of the event as a Secondary BSI. In these instances, along with the over-reported events, facilities most often incorrectly applied the site-specific criteria for pneumonia. Of the seven events that were reported incorrectly, the most common reporting errors were incorrect location due to the transfer rule and incorrect event date, specifically when the symptom occurred before the culture date when applying Laboratory-Confirmed Bloodstream Infection (LCBI) criteria 2. The SHD will use these results to tailor NHSN training and education to facilities. Accurate reporting to the National Healthcare Safety Network (NHSN) is critical in providing actionable surveillance data to inform infection prevention (IP) programs. The state health department (SHD) validated Central Line-Associated Bloodstream Infections (CLABSI) to assess data accuracy and identify common reporting errors. Utilizing the NHSN external validation toolkit, the SHD validated 21 facilities based on data reported from Intensive Care Units (ICU) and Medical, Surgical, and Medical/Surgical Ward locations during January to June 2018. Nine facilities were selected for both ICU and Ward locations, 6 for ICU only and 6 for Ward only. For each facility, up to 20 reported NHSN CLABSI events and up to 40 unreported or candidate events were reviewed. Patient medical records were reviewed to determine if the selected blood culture met CLABSI event criteria. The SHD reviewed a total of 1112 medical records. The SHD identified 120 reportable CLABSI events; of these, 7/120 (6%) were reported with errors and 10/120 (8%) were not reported at all. Additionally, the SHD found two reported events that were deemed Secondary Bloodstream Infections (BSI); therefore, did not meet primary CLABSI criteria and were subsequently over-reported. The overall sensitivity was 92% and specificity was 99.8%. Facility specific sensitivities ranged from 71% to 100%. The majority of unreported CLABSI events were due to misattribution of the event as a Secondary BSI. In these instances, along with the over-reported events, facilities most often incorrectly applied the site-specific criteria for pneumonia. Of the seven events that were reported incorrectly, the most common reporting errors were incorrect location due to the transfer rule and incorrect event date, specifically when the symptom occurred before the culture date when applying Laboratory-Confirmed Bloodstream Infection (LCBI) criteria 2. The SHD will use these results to tailor NHSN training and education to facilities.