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Published on: July 13, 2019
Evaluating the Adequacy of Central Line-Associated Bloodstream Infection As a Quality Measure: A Cross-Sectional
Piyush Mathur1, Amanda J Naylor1,2, Moises Auron2,3
1Department of Anesthesiology, Cleveland Clinic, Cleveland, OH.
Importance:
The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source.
Objectives:
We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure.
Design Setting And Participants:
Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source.
Main Outcomes And Measures:
CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed.
Results:
A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, Staphylococcus and Candida were the predominant organisms. For the CVC unrelated and unclear groups Enterococcus was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%.
Conclusions And Relevance:
The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1-67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.
Insights
The current definition of central line-associated bloodstream infection (CLABSI) is inadequate, with only 58% accuracy. Revisions are needed to better identify true catheter-related infections and improve patient outcomes.
Area of Science:
- Infectious Diseases
- Healthcare Quality Improvement
- Epidemiology
Background:
- The definition of central line-associated bloodstream infection (CLABSI) may overestimate true incidence due to unclear attribution to central lines versus other sources.
- Accurate identification of CLABSI is crucial for quality measurement and effective infection control strategies.
Purpose of the Study:
- To assess the prevalence and outcomes of CLABSI at a tertiary care hospital.
- To identify gaps in the current CLABSI definition and its application as a quality metric.
- To guide improvements in infection reduction efforts.
Main Methods:
- Retrospective cross-sectional study of 340 CLABSI episodes in value-based purchasing units (2018-2022).
- Classification of episodes as CVC-related, CVC-unrelated, or unclear source.
- Assessment of mortality and documentation of infectious source.
Main Results:
- 31.5% of CLABSI episodes were unrelated to the central venous catheter (CVC), and 25.0% had an unclear source.
- The positive predictive value (PPV) of the CDC CLABSI definition for true CVC-related infection was 58.0%.
- Mortality rates were lowest for CVC-related bloodstream infections.
Conclusions:
- The current CLABSI definition is inadequate as a surrogate for catheter-related bloodstream infections.
- Efforts should focus on revising the CLABSI definition and investigating secondary sources of bloodstream infections.
- Resources are needed to improve the accuracy of CLABSI surveillance and prevention.
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