Conflicting methods of defining Central Line Blood Stream Infections (CLABSI)

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Intravenous literature: Moehring, R.W., Staheli, R., Miller, B.A., Chen, L.F., Sexton, D.J. and Anderson, D.J. (2013) Central Line–Associated Infections as Defined by the Centers for Medicare and Medicaid Services’ Hospital-Acquired Condition versus Standard Infection Control Surveillance: Why Hospital Compare Seems Conflicted. Infection Control and Hospital Epidemiology. 34(3), p.238-244.

Abstract:

Objective – To evaluate the concordance of case-finding methods for central line–associated infection as defined by Centers for Medicare and Medicaid Services (CMS) hospital-acquired condition (HAC) compared with traditional infection control (IC) methods.

Setting – One tertiary care and 2 community hospitals in North Carolina.

Patients – Adult and pediatric hospitalized patients determined to have central line infection by either case-finding method.

Methods – We performed a retrospective comparative analysis of infection detected using HAC versus standard IC central line–associated bloodstream infection surveillance from October 1, 2007, through December 31, 2009. One billing and 2 IC databases were queried and matched to determine the number and concordance of cases identified by each method. Manual review of 25 cases from each discordant category was performed. Sensitivity and positive predictive value (PPV) were calculated using IC as criterion standard.

Results – A total of 1,505 cases were identified: 844 by International Classification of Diseases, Ninth Revision (ICD-9), and 798 by IC. A total of 204 cases (24%) identified by ICD-9 were deemed not present at hospital admission by coders. Only 112 cases (13%) were concordant. HAC sensitivity was 14% and PPV was 55% compared with IC. Concordance was low regardless of hospital type. Primary reasons for discordance included differences in surveillance and clinical definitions, clinical uncertainty, and poor documentation.

Conclusions – The case-finding method used by CMS HAC and the methods used for traditional IC surveillance frequently do not agree. This can lead to conflicting results when these 2 measures are used as hospital quality metrics.

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