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Significant variations found in bloodstream infection surveillance methods
Lin MY. JAMA. 2010; 304: 2035-2041.
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Researchers have identified differences in surveillance methods used for central line-associated bloodstream infections, leading to significant variations in publicly reported rates, according to new findings published in the Journal of the American Medical Association.
Central line-associated bloodstream infection (CLA-BSIs) rates are publicly reported to compare the quality of patient care delivered by hospitals and to improve patient safety.
Researchers for the CDC Prevention Epicenter Program set out to assess CLA-BSIs rates across 20 ICUs at four medical centers between 2004 and 2007. Unit-specific CLA-BSIs were calculated during 1 year intervals.
The median rate for CLA-BSI determined by an infection preventionist was 3.3 infections per 1,000 central-line days vs. a median rate of 9 infections per 1,000 central-line days determined by computer algorithm.
A weak overall correlation was observed between the infection preventionist and computer algorithm (P=.34).
In addition, point estimates as stratified by medical center varied widely:
- medical center A (0.83; 95% CI, 0.05-0.98);
- medical center B (0.76; 95% CI, 0.32-0.93);
- medical center C (0.50; 95% CI, -0.11to 0.83);
- and medical center D (0.10; 95% CI,-0.53 to 0.66).
The institution with the lowest rate for CLA-BSI by traditional methods (2.4 infections per 1,000 central-line days) had the highest rate determined by computer algorithm (12.6 infections per 1,000 central-line days).
“Institutional variability of infection preventionist rates relative to a computer algorithm reference standard suggests that there is significant variation in the application of standard central-line associated CLA-BSI surveillance definitions across medical centers,” the researchers wrote.
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