Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics

Area of Science:

• Healthcare Quality Improvement
• Infectious Disease Prevention
• Hospital Administration

Background:

• Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are key ICU quality metrics.
• Financial penalties are often tied to performance on these infection metrics.
• Concerns exist regarding the evidence base, definitions, and moral distress associated with these metrics.

Purpose of the Study:

• To critically evaluate the challenges and issues surrounding the use of CLABSI and CAUTI metrics.
• To incorporate international perspectives on healthcare-associated infection surveillance.
• To propose practical recommendations for improving the application of CLABSI and CAUTI metrics.

Main Methods:

• Review of existing literature and data on CLABSI and CAUTI surveillance.
• Analysis of the evidence base supporting the impact of these metrics on infection rates.
• Discussion of provider-related issues, including moral distress and definitional problems.
• Consideration of international viewpoints and best practices.

Main Results:

• The evidence linking CLABSI and CAUTI metric documentation to decreased infection rates is not robust.
• Significant challenges include definitional ambiguities and the moral distress experienced by clinicians.
• International perspectives highlight varied approaches to infection surveillance and metric utilization.

Conclusions:

• The current use of CLABSI and CAUTI metrics requires critical re-evaluation due to identified issues.
• A multidisciplinary task force involving providers, payers (e.g., CMS), and patients is recommended.
• Developing a consensus statement with actionable recommendations is essential for optimizing the utility of these quality metrics.