Classification of CLABSI definitions for those conducting surveillance

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Intravenous literature: Mayer, J., Greene, T., Howell, J., Ying, J., Rubin, M.A., Trick, W.E. and Samore, M.H. (2012) Agreement in Classifying Bloodstream Infections Among Multiple Reviewers Conducting Surveillance. Clinical Infectious Diseases. Apr 26. [Epub ahead of print].

Abstract:

Background – Mandatory reporting of healthcare associated infections (HAI) is increasing. Evidence for agreement among different reviewers applying HAI surveillance criteria is limited. We aim to characterize agreement among Infection Preventionists (IPs) conducting surveillance for central line-associated bloodstream infection (CLABSI) with each other and as compared to simplified laboratory-based definitions.

Methods – Abstracted electronic health records were assembled from in-patients with positive blood cultures at a tertiary care Veterans Affairs (VA) hospital over a 5-year period. Identical patient records were made available to VA IPs from different facilities to report on CLABSI using their usual surveillance methods. Positive blood cultures were also evaluated using laboratory-based definitions. Standard indices of inter-rater agreement, expressed as a kappa statistic, were computed between IPs, and between IPs and simplified laboratory-based methods.

Results – Overall, 114 patient records were reviewed by 18 IPs, the majority of whom specified they followed National Healthcare Safety Network (NHSN) criteria. The overall agreement amongst IPs by kappa was 0.42 (SE 0.06). IPs had better agreement with a simple laboratory-based definition with an average kappa of 0.55 (SE 0.05). The proportion of patient records that 18 IPs reported with CLABSI ranged from 14% to 39% (overall mean 28% with a CV of 25%). When simple laboratory-based methods were applied to different sets of patient records, classification was more consistent with CLABSI assigned in a proportion ranging from 36% to 42% (overall mean 39%).

Conclusion – Reliability of IP-conducted surveillance to identify HAI may not be ideal for public reporting goals of inter-hospital comparisons.

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