Can the central line-associated blood stream infection (CLABSI) definition be refined to include primarily those infections relevant to infection control practices?

Includes bibliographical references (pages 68-71).Background: A Central Line-Associated Blood Stream Infection (CLABSI) is one of the most deadly types of healthcare-associated infection (HAI). Around 250,000 CLABSIs occur per year in the U.S. and the mortality rate ranges from 12-15%. The cost of a single CLABSI ranges from $5,734-$22,939.CLABSI surveillance is required by all hospitals and the data is publicly reported. This has two main consequences: financial repercussions and negative reputation. As a result, it is important for surveillance to be accurate. Intensive care (IC) professionals feel that CLABSIs are likely over-reported as a result of special populations. The CDC updated the CLABSI definition in January 2013; however, the impact of this current definition on CLABSI rates is unknown. Further research is needed to determine how the current CLABSI surveillance definition impacts CLABSI rates, and to determine if other risk factors should be considered for exclusion from the definition. The overall goal is to refine the CLABSI surveillance definition to include primarily those cases related to IC practices. Methods: A retrospective case review was conducted on Scripps Mercy hospital inpatients with a CLABSI between June 2008 and November 2012. One hundred forty two patients were reviewed using EMRs and paper charts. The source of infection was categorized for each case based off of data pulled from their charts. Data analysis was performed using SAS 9.2. Descriptive statistics were run for all variables, a student t-test was used to compare CLABSI rates and multinomial logistic regression was used to create general and final models. Results: There was a significant decrease (15%) in the CLABSI rate between the prior CDC CLABSI definition and the current CDC CLABSI definition (p = 0.0012). The CLABSI rate significantly decreased (49%) between the current CDC CLABSI definition and this study's proposed definition (p ??? 0.0001). This study also looked at two risk factors for a likely endogenous source of infection. Intra-abdominal surgery was not significantly associated with a likely endogenous source of infection. The risk for intra-abdominal patients was 1.237 times higher than those who did not have surgery. Neutropenia was not significantly associated with endogenous source of infection. The risk for neutropenic patients was 2.79 times higher than non-neutropenics. This study also looked at single Enterococcus cultures as likely contaminants. Single Enterococcus cultures were significantly associated with likely contaminants (0.0097). Conclusions: The current CDC CLABSI definition was successful at significantly reducing the CLABSI rate at Scripps Mercy hospital. This definition eliminated CLABSI cases that were likely endogenous sources of infection in neutropenic patients. There is still no component to the definition that looks at post-operative patients or single Enterococcus cultures. This study found that single Enterococcus cultures are significantly associated with likely contaminants. Therefore, future studies should focus on these criteria so that the CDC CLABSI definition can be refined to include primarily those cases related to IC practices