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Laboratory-based surveillance better for public reporting of HAIs
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Recent data suggest that surveillance conducted by infection preventionists for health care-associated infections do not always agree and may not be sufficient for public reporting.
Researchers from the University of Utah School of Medicine evaluated electronic health records from inpatients who had positive blood cultures while at a Veterans Affairs hospital within a 5-year period. Similar records were given to VA infection preventionists to report on central line-associated bloodstream infections using their surveillance methods. The researchers computed the agreement between the laboratory-based methods and the infection preventionists and between different infection preventionists.
The study included 114 admissions between January 2001 and December 2005 who had blood cultured more than 2 days after admission and who had central line-associated bloodstream infections. Their records were reviewed by 18 different infection preventionists from VA hospitals.
When applying a laboratory-based algorithm, the classification of central line-associated bloodstream infection was assigned to 36% to 42% of patient records. However, the infection preventionists classified 14% to 39% of patient records with a central line-associated bloodstream infection, showing that the proportion of patient records classified as a central line-associated bloodstream infection varied among infection preventionists.
There were also differences identified in the certainty of the infection preventionists as to whether there was a central line-associated blood stream infection. One infection preventionist was certain in only 20% of the patient records, whereas one infection preventionist was certain in 97% of the records.
“Our results support the use of laboratory-based definitions as better suited for public reporting of infection rates when the primary goal is to rank facilities,” the researchers wrote. “There is a need for infection preventionists, health care epidemiologists and policy makers to come to consensus on the value and limitations of more streamlined objective quantitative measures of identifying health care-associated infections.”
References:
Mayer J. Clin Infect Dis. 2012;55:364-370.
Disclosures:
The researchers report no relevant financial disclosures.