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Publicly reported CLABSI incidence consistently underestimated
Findings from a systemic review showed a consistent underestimation of the incidence of central line-associated bloodstream infections, or CLABSIs, within publicly reported rates, “weakening the validity and reliability of surveillance measures,” researchers wrote.
An estimated 65% to 70% of CLABSIs are considered preventable, and “continuous and reliable” surveillance is essential, said Emily N. Larsen, GDip(HlthRes), senior research assistant with the Alliance for Vascular Access Teaching and Research Group at Griffith University in Australia, and colleagues.
“This systematic review, conducted by the Alliance for Vascular Access Teaching and Research and Griffith University, included studies which compared publicly reported CLABSI rates with expert reviewers,” Larsen explained to Infectious Disease News. “The team found there was consistent underestimation of CLABSI, with low sensitivity.”
The review included nine studies with a total of 7,160 central lines. The researchers found that CLABSI rates were underestimated in seven studies and overestimated in two studies. The specificity of the studies ranged from 0.7 (95% CI, 0.58-0.81) to 0.99 (95% CI, 0.99-1), and the sensitivity ranged from 0.42 (95% CI, 0.15-0.72) to 0.88 (95% CI, 0.77-0.95).
“In most cases, publicly reported CLABSI rates did not include patients who experienced a true case of CLABSI,” Larsen and colleagues wrote.
In four studies that included consecutive series of patients — rather than random samples — reported CLABSI incidence was between 9.8% and 20.9%, and absolute rates were underestimated by 3.3% to 4.4%, Larsen and colleagues reported.
The researchers said underestimating true CLABSI incidence in publicly reported rates could have “widespread effects.”
“Health care institutions and clinicians rely on CLABSI surveillance as a measure of the quality of care provided; and to inform benchmarking and quality improvement strategies into the future,” Larsen said.
Larsen and colleagues noted the need for auditing, education and adequate resource allocation.
“Accuracy of data is essential to ensure the strategies we employ to prevent CLABSI are indeed having the effect clinicians and policymakers believe they are,” Larsen said. “Based on these findings we would highly encourage facilities to validate their own data (publish where possible) and, where discrepancies are found, reinvest time, resources and education opportunities to infection preventionists (or those otherwise responsible for reporting), to ensure [these] data [are] reliable and trustworthy.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.