AJIC: Institutions measure blood stream infection rates differently

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There is substantial variation in reported catheter-related bloodstream infections (CA-BSI) surveillance practices among pediatric intensive care units (PICUs), and more aggressive surveillance correlates to higher CA-BSI rates, which has implications in pay-for-performance and benchmarking applications, according to an article in this month's American Journal of Infection Control.

“Catheter-related bloodstream infections are an important quality performance measure and remain a significant source of added morbidity, mortality and medical costs,” wrote Matthew Niedner, MD, assistant professor of pediatrics and communicable diseases at University of Michigan C.S. Mott Children's Hospital in Ann Arbor, and colleagues.

The study, conducted by the National Association of Children's Hospitals and Related Institutions PICU Focus Group, assessed variability in CA-BSI surveillance practices, management and attitudes/beliefs in PICUs to determine whether any correlation exists between surveillance variation and CA-BSI rates.

One hundred forty-six respondents from five professions in 16 PICUs completed surveys with a response rate of 40 percent, according to the researchers. All 10 infection control departments reported inclusion or exclusion of central line types inconsistent with the Centers for Disease Control and Prevention CA-BSI definition. Fifty percent calculated line-days inconsistently and five used a strict, written policy for classifying BSIs, the research found.

Infection control departments reported substantial variation in methods, timing and resources used to screen and adjudicate BSI cases. Greater than 80 percent of centers reported having a formal, written policy about obtaining blood cultures, although less than 80 percent of these address obtaining samples from patients with central venous lines, and any such policies are reportedly followed less than half of the time. Substantial variation exists in blood culturing practices, such as temperature thresholds, preemptive antipyretics, and blood sampling (volumes, number, sites, frequencies), the authors wrote.

A surveillance aggressiveness score was devised to quantify practices likely to increase identification of bloodstream infections, and there was a significant correlation between the surveillance aggressiveness score and CA-BSI rates. In assessing attitudes and beliefs, Niedner and colleagues found there was much greater confidence in the validity of CA-BSI as an internal/historical benchmark than as an external/peer benchmark. The factor most commonly believed to contribute to CA-BSI occurrences was patient risk factors, not central line maintenance or insertion practices.

“There is a compelling opportunity to improve standardized CA-BSI surveillance to enhance the validity of this metric for interinstitutional comparisons,” Niedner concluded. “Healthcare professionals' attitudes and beliefs about CA-BSI being driven by patient risk factors would benefit from recalibration that emphasized more important drivers—such as the quality of central line insertion and maintenance.”