American Journal of Infection Control 43 (2015) 280-2
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Effect of 2013 National Healthcare Safety Network definition changes on central line bloodstream infection rates: Audit results from the New York State Department of Health Peggy Ann Hazamy RN, BSN, CIC *, Valerie B. Haley PhD, Boldtsetseg Tserenpuntsag DrPH, Marie Tsivitis MT(ASCP), MPH, Rosalie Giardina MT(ASCP), Robin Knab CLT, M(ASCP), Emily Lutterloh MD, MPH New York State Hospital Acquired Infection Reporting Program, New York State Department of Health, Buffalo, NY
Key Words: Central lineeassociated bloodstream infection rates Central lineeassociated bloodstream infection audit Criteria changes
Surveillance criteria for central lineeassociated bloodstream infections (CLABSIs) are continually being refined to more accurately reflect infections related to central lines. An audit of 567 medical records from adult, pediatric, and neonatal intensive care unit patients with a central line and a positive blood culture showed a 16% decrease in CLABSI rates after the 2013 National Healthcare Safety Network definitions compared with the 2012 definitions. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The New York State (NYS) Hospital-Acquired Infection Reporting Program is required by state law to audit data that will be used for public reporting. Currently, 164 facilities with intensive care units (ICUs) are mandated to report hospital-acquired central linee associated bloodstream infections (CLABSIs). Facilities are required to enter data into the National Healthcare Safety Network (NHSN) after standardized surveillance definitions established by the Centers for Disease Control and Prevention.1 Validation of data submitted to the NHSN not only determines the accuracy of data elements entered into the NHSN but provides insight into the level of understanding of surveillance criteria and the impact of data discrepancies.2 Hospital-acquired infection (HAI) data are used by health care facilities to track improvements and state and federal agencies for public reporting and payment purposes to promote improvement in infection prevention practices. The implications of the use of these data have increased the emphasis on data quality and led to “revising definitions in ways that reduce complexity, maintain clinical relevance, and avoid potential case misclassification.”3 The NYS Department of Health evaluated a sample of charts using both the 2012 and 2013 NHSN definitions to measure the impact of the definition change on reported CLABSI rates.
* Address correspondence to Peggy Ann Hazamy, RN, BSN, CIC, New York State Department of Health, Hospital Acquired Infection Reporting Program, Western Regional Office, 584 Delaware Ave, Buffalo, NY 14202. E-mail address: [email protected] (P.A. Hazamy).
The 2013 CLABSI definition changes mainly involved clarifying the timing of HAIs and simplifying measurements from hourly to calendar day units. A comparison of 2012 and 2013 definitions is provided in Table 1. The 2013 CLABSI definition requires a hospital stay of at least 3 days, a line in place for >2 calendar days, and the laboratoryconfirmed bloodstream infection criteria fully met on the day of device discontinuation or the following calendar day. Figure 1 shows an example where the criteria change reduces the window in which to apply the CLABSI definition from almost 5 to 2 days. METHODS The NYS audit process uses a standardized electronic data collection form for retrospective chart review. Chart selection was based on a hospital-provided chronologic list of ICU patients with a positive blood culture drawn in an ICU during a specified time frame. All charts were reviewed to determine if the blood cultures met the 2012 and 2013 definitions. If a blood culture met the 2012 definition but not the 2013 definition, the reason for the difference was recorded. Because >1 response was possible, we categorized the responses using the following hierarchy: 1. Not an HAI in 2013 because the patient was in the hospital for 2 calendar days, or the event had to have occurred on the day of device discontinuation or the following day. In this example, where the CL was removed on day 3 and the event occurred on day 5, this CLABSI would not be reportable. A reportable CLABSI was possible at any point in the 2013 definition time block. In 2012, a CLABSI could be reportable if it occurred on the same day as the CL insertion, on the day of admission, and within 48 hours of removal. In this example, a reportable CLABSI was possible at any point in the 2012 definition time block. CL, central line; CLABSI, central lineeassociated bloodstream infection.
3. Not an HAI in 2013 because blood draws were not within 2 days. 4. Not an HAI in 2013 because the central line was not in place for the day of event or the day before. All who met the definition in 2013 would also have met the definition in 2012. RESULTS Between September 2013 and June 2014, 60 facilities were audited by 4 NYS staff certified in infection prevention. Records for a total of 1,086 ICU patients with a positive blood culture were initially reviewed, and 567 (52%) patients underwent complete review because the patient also had a central line during the ICU stay and before the selected blood culture was drawn. Of these, 106 met the 2012 CLABSI definition; of those, 89 met the 2013 definition. The remaining 17 met the 2012 definition but not the 2013 definition. The number of CLABSIs identified using the 2013
Charts reviewed with central line and positive blood culture CLABSIs using the 2012 definition CLABSIs using the 2013 definition CLABSIs that met the 2012 definition and not the 2013 definition Reasons for discrepancies (hierarchical list) Patient in hospital
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Effect of 2013 National Healthcare Safety Network definition changes on central line bloodstream infection rates: Audit results from the New York State Department of Health Peggy Ann Hazamy RN, BSN, CIC *, Valerie B. Haley PhD, Boldtsetseg Tserenpuntsag DrPH, Marie Tsivitis MT(ASCP), MPH, Rosalie Giardina MT(ASCP), Robin Knab CLT, M(ASCP), Emily Lutterloh MD, MPH New York State Hospital Acquired Infection Reporting Program, New York State Department of Health, Buffalo, NY
Key Words: Central lineeassociated bloodstream infection rates Central lineeassociated bloodstream infection audit Criteria changes
Surveillance criteria for central lineeassociated bloodstream infections (CLABSIs) are continually being refined to more accurately reflect infections related to central lines. An audit of 567 medical records from adult, pediatric, and neonatal intensive care unit patients with a central line and a positive blood culture showed a 16% decrease in CLABSI rates after the 2013 National Healthcare Safety Network definitions compared with the 2012 definitions. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The New York State (NYS) Hospital-Acquired Infection Reporting Program is required by state law to audit data that will be used for public reporting. Currently, 164 facilities with intensive care units (ICUs) are mandated to report hospital-acquired central linee associated bloodstream infections (CLABSIs). Facilities are required to enter data into the National Healthcare Safety Network (NHSN) after standardized surveillance definitions established by the Centers for Disease Control and Prevention.1 Validation of data submitted to the NHSN not only determines the accuracy of data elements entered into the NHSN but provides insight into the level of understanding of surveillance criteria and the impact of data discrepancies.2 Hospital-acquired infection (HAI) data are used by health care facilities to track improvements and state and federal agencies for public reporting and payment purposes to promote improvement in infection prevention practices. The implications of the use of these data have increased the emphasis on data quality and led to “revising definitions in ways that reduce complexity, maintain clinical relevance, and avoid potential case misclassification.”3 The NYS Department of Health evaluated a sample of charts using both the 2012 and 2013 NHSN definitions to measure the impact of the definition change on reported CLABSI rates.
* Address correspondence to Peggy Ann Hazamy, RN, BSN, CIC, New York State Department of Health, Hospital Acquired Infection Reporting Program, Western Regional Office, 584 Delaware Ave, Buffalo, NY 14202. E-mail address: [email protected] (P.A. Hazamy).
The 2013 CLABSI definition changes mainly involved clarifying the timing of HAIs and simplifying measurements from hourly to calendar day units. A comparison of 2012 and 2013 definitions is provided in Table 1. The 2013 CLABSI definition requires a hospital stay of at least 3 days, a line in place for >2 calendar days, and the laboratoryconfirmed bloodstream infection criteria fully met on the day of device discontinuation or the following calendar day. Figure 1 shows an example where the criteria change reduces the window in which to apply the CLABSI definition from almost 5 to 2 days. METHODS The NYS audit process uses a standardized electronic data collection form for retrospective chart review. Chart selection was based on a hospital-provided chronologic list of ICU patients with a positive blood culture drawn in an ICU during a specified time frame. All charts were reviewed to determine if the blood cultures met the 2012 and 2013 definitions. If a blood culture met the 2012 definition but not the 2013 definition, the reason for the difference was recorded. Because >1 response was possible, we categorized the responses using the following hierarchy: 1. Not an HAI in 2013 because the patient was in the hospital for 2 calendar days, or the event had to have occurred on the day of device discontinuation or the following day. In this example, where the CL was removed on day 3 and the event occurred on day 5, this CLABSI would not be reportable. A reportable CLABSI was possible at any point in the 2013 definition time block. In 2012, a CLABSI could be reportable if it occurred on the same day as the CL insertion, on the day of admission, and within 48 hours of removal. In this example, a reportable CLABSI was possible at any point in the 2012 definition time block. CL, central line; CLABSI, central lineeassociated bloodstream infection.
3. Not an HAI in 2013 because blood draws were not within 2 days. 4. Not an HAI in 2013 because the central line was not in place for the day of event or the day before. All who met the definition in 2013 would also have met the definition in 2012. RESULTS Between September 2013 and June 2014, 60 facilities were audited by 4 NYS staff certified in infection prevention. Records for a total of 1,086 ICU patients with a positive blood culture were initially reviewed, and 567 (52%) patients underwent complete review because the patient also had a central line during the ICU stay and before the selected blood culture was drawn. Of these, 106 met the 2012 CLABSI definition; of those, 89 met the 2013 definition. The remaining 17 met the 2012 definition but not the 2013 definition. The number of CLABSIs identified using the 2013
Charts reviewed with central line and positive blood culture CLABSIs using the 2012 definition CLABSIs using the 2013 definition CLABSIs that met the 2012 definition and not the 2013 definition Reasons for discrepancies (hierarchical list) Patient in hospital
