Validation of hospital-reported Central Line Associated Bloodstream Infections (CLABSI)

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Intravenous literature: Oh, J.Y., Cunningham, M.C., Beldavs, Z.G., Tujo, J., Moore, S.W., Thomas, A.R. and Cieslak, P.R. (2012) Statewide Validation of Hospital-Reported Central Line

Associated Bloodstream Infections: Oregon, 2009. Infection Control and Hospital Epidemiology. 33(5), p.439-445.

Abstract:

Background: Mandatory reporting of healthcare-associated infections is common, but underreporting by hospitals limits meaningful interpretation.

Objective: To validate mandatory intensive care unit (ICU) central line associated bloodstream infection (CLABSI) reporting by Oregon hospitals.

Design: Blinded comparison of ICU CLABSI determination by hospitals and health department–based external reviewers with group adjudication.
setting. Forty-four Oregon hospitals required by state law to report ICU CLABSIs.

Participants: Seventy-six patients with ICU CLABSIs and a systematic sample of 741 other patients with ICU-related bacteremia
episodes.

Methods: External reviewers examined medical records and determined CLABSI status. All cases with CLABSI determinations discordant from hospital reporting were adjudicated through formal discussion with hospital staff, a process novel to validation of CLABSI reporting.

Results: Hospital representatives and external reviewers agreed on CLABSI status in 782 (96%) of 817 bacteremia episodes (k p 0.77 [95% confidence interval]. Among the 27 episodes identified as CLABSIs by external reviewers but not reported by hospitals, the final status was CLABSI in 16 (59%). The measured sensitivities of hospital ICU CLABSI reporting were 72% with adjudicated CLABSI determination as the reference standard and 60%  with external review alone as the reference standard (P p .07). Validation increased the statewide ICU CLABSI rate from 1.21  to 1.54  CLABSIs/1,000 central line days; ICU CLABSI rates increased by more than 1.00 CLABSI/1,000 central line days in 6 (14%) hospitals.

Conclusions: Validating hospital CLABSI reporting improves accuracy of hospital-based CLABSI surveillance. Discussing discordant findings improves the quality of validation.

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