Validation of the surveillance and reporting of central line-associated bloodstream infection denominator data

Area of Science:

• Healthcare-associated infections
• Infection control
• Healthcare quality improvement

Background:

• Accurate surveillance of central line-associated infections (CLABIs) relies on both case identification and denominator data.
• Denominator data, specifically patient-day (PD) and central line-day (CLD) counts, has received less attention than case validation.
• This study addresses the accuracy of CLABSI denominator reporting to the National Healthcare Safety Network (NHSN).

Purpose of the Study:

• To evaluate the accuracy of patient-day (PD) and central line-day (CLD) counts reported by acute care hospitals to the NHSN.
• To identify potential discrepancies in denominator data collection for CLABSI surveillance.

Main Methods:

• A blinded retrospective chart review was conducted by the Connecticut Department of Public Health (CT DPH).
• Data from 23 acute care hospitals were reviewed for 9 selected days in the fourth quarter of 2009.
• The review focused on the collection of CLABSI PD and CLD, comparing hospital counts with CT DPH findings.

Main Results:

• A total of 1,988 intensive care unit patient charts were reviewed.
• Hospitals over-reported PD by 17.2% and CLD by 21.7%.
• Manual data collection methods for PD were more accurate than electronic methods (P < .01); no significant difference was found for CLD collection methods (P > .05). Wednesday PD counts were more accurate than Monday or Saturday counts.

Conclusions:

• Hospitals demonstrated inaccuracies in reporting CLABSI denominator data (PD and CLD) to the NHSN.
• Manual data collection for PD was more accurate than electronic methods.
• Internal validation of denominator data by hospitals is recommended before submission to national surveillance systems.