The Impact of the National Healthcare Safety Network Mucosal Barrier Injury Laboratory-confirmed Bloodstream Infection Definition on a Hematology Oncology Unit

Abstract

ISSUE: Our 28 bed Hematology Oncology (Heme-Onc) unit has had an unacceptably high central line assosciated bloodstream infection (CLABSI) rate. This patient population with various hematologic malignancies, including stem cell transplants, is at high risk for neutropenia, mucositis and graft-versus-host disease. Despite aggressive prevention efforts with implementation of multiple evidence-based CLABSI interventions over a 3 year period, no significant reduction in the CLABSI rate was achieved. PROJECT: Applying the new January 2013 National Healthcare Safety Network (NHSN) mucosal barrier injury laboratoryconfirmed bloodstream infection (MBI-LCBSI) definition, we identified that 80% of the CLABSIs on our Heme-Onc unit met the MBI-LCBSI definition for the first quarter of 2013. To determine if this finding was new, all CLABSIs from 2012 on this Heme-Onc unit were retrospectively reviewed applying the 2013 NSHN MBILCBI definition. Tracking of the CLABSI rate excluding the MBI-LCBSIs continued in 2013. Chi square tests were performed to determine if the overall CLABSI rate was significantly different than the CLABSI rate excluding MBI-LCBIs for both 2012 and 2013. RESULTS: The overall CLABSI rate in 2012 was 4.07 BSI/1,000 device days. 67.6% of the CLABSIs in 2012met the definition for MBI-LCBSI. The CLABSI rate, excluding MBI-LCBSIs, was 1.32 BSI/1,000 device days. For the first eleven months of 2013, the overall CLABSI rate was 3.6 BSI/1,000 device days. 77.8 % of the CLABSIs met the MBI-LCBSI definition in 2013. The CLABSI rate, excluding the MBI-LCBIs, was 0.8 BSI/1,000 device days. There was a significant difference between the rates in 2012, (c2 (1) 1⁄4 11.72, p < .01) as well as in 2013, (c2 (1) 1⁄4 13.33, p < .01).