Variations in CLABSI surveillance

At a recent client meeting, an infection preventionist asked how to ensure consistency in infection reporting among hospitals, considering infection rates will soon be published on CDC's Hospital Compare website. I am not sure anyone has an answer to her question, but given the recent study results published on CLABSI surveillance, there exist large variations in how hospitals measure and report CLABSI rates. The study suggests that a lot of work remains to be done to ensure consistency and validity in how hospitals conduct CLABSI surveillance.

Here are some of the findings from the study, which was published in the October issue of the American Journal for Infection Control (AJIC):

• 100% of the infection control departments reported inclusion or exclusion of central line types inconsistent with the CDC CA-BSI definition
• 50% calculated line-days inconsistently
• Only 50% used a strict, written policy for classifying BSIs
• Though more than 80% of the hospitals surveyed reported having a formal, written policy about obtaining blood cultures, less than 80% of these address obtaining samples from patients with central venous lines, and any such policies are reportedly followed less than half of the time
• Substantial variation exists in blood culturing practices, such as temperature thresholds, preemptive antipyretics, and blood sampling (volume, number, sites, frequency).

Finally, hospitals expressed much greater confidence in the validity of CA-BSI as an internal/historical benchmark than as an external/peer benchmark, and the factor most commonly believed to contribute to CA-BSI occurrences was patient risk factors, not central line maintenance or insertion practices.