Evaluation of hospital-onset bloodstream infections compared to central line...associated bloodstream infections at an acute, tertiary care hospital

BACKGROUND

Central line...associated bloodstream infection (CLABSI) is the current benchmark used in HAI (Hospital-associated infection) surveillance and effective interventions have greatly reduced the incidence in recent years. However, bloodstream infection (BSI) continues to be a major source of morbidity and mortality in hospitals. Hospital-onset bloodstream infection (HOBSI), which includes central and peripheral line surveillance, may be a more sensitive indicator of preventable BSI. Our objective is to assess the impact of a change to HOBSI surveillance by comparing the incidence of BSIs using the National Health care and Safety Network LabID and BSI definitions compared to CLABSI.

METHODS

Utilizing electronic medical charts, we determined if each blood culture met the HOBSI criteria according to the National Health care and Safety Network LabID and BSI definitions. We calculated the incidence rates (IRs) per 10,000 patient days for both definitions and compared them to the CLABSI rate per 10,000 patient days for the same period.

RESULTS

The IR of HOBSI using the LabID definition was 10.25. Using the BSI definition, we found an IR of 3.77. The IR of CLABSI for the same period was 1.84.

CONCLUSIONS

After excluding secondary BSIs, the HOBSI rate is still double that of the CLABSI rate. HOBSI surveillance is a more sensitive indicator of BSI than CLABSI, and thus a better target for monitoring effectiveness of interventions.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network Data Quality Collaboration Case Study - Chapter 9 Surgical site infection event (SSI) case study

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of common surveillance concepts included in the Patient Safety Component, Chapter 9 - Surgical Site Infection Event (SSI). The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).

Health care-associated infections studies project: An American journal of infection control and national healthcare safety network data quality collaboration case study - Chapter 2 Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance case study vignettes

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of three of the surveillance concepts included in the Patient Safety Component, Chapter 2 - Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).

Developing valid test bank of surveillance case study scenarios for inter-rater reliability

Case studies are utilized for training on National Healthcare Safety Network (NHSN) healthcare associated infection surveillance definitions. Item discrimination and item analysis were applied to case studies to identify questions that most accurately assess infection preventionists (IPs) application of surveillance definitions.

Non-ventilator health care-associated pneumonia (NV-HAP): Pediatrics

There is a paucity of data on the prevalence, risk factors or prevention of nonventilator health care-associated pneumonia (NV-HAP) in children. As with adults, viral, fungal and bacterial infections can lead to NV-HAP, but surveillance definitions and case ascertainment remain a challenge. This section will review the known epidemiology of NV-HAP in the pediatric population, risk factors, surveillance, and prevention practices. Prevention strategies specific to pediatrics, aimed at reducing risk of viral transmission to hospitalized children will be discussed.

Self-reported National Healthcare Safety Network knowledge and enrollment: A national survey of nursing homes

Predictors of nursing home staff knowledge of the National Healthcare Safety Network (NHSN) and facility enrollment were explored in a national survey. Facility participation in Quality Innovation Network-Quality Improvement Organization initiatives was positively associated with both knowledge and enrollment. In addition, engaging clinical personnel in decision making on NHSN enrollment was positively associated with staff knowledge of NHSN.

The expansion of National Healthcare Safety Network enrollment and reporting in nursing homes: Lessons learned from a national qualitative study

BACKGROUND

This study explored nursing home (NH) personnel perceptions of the National Healthcare Safety Network (NHSN).

METHODS

NHs were purposively sampled based on NHSN enrollment and reporting status, and other facility characteristics. We recruited NH personnel knowledgeable about the facility's decision-making processes and infection prevention program. Interviews were conducted over-the-phone and audio-recorded; transcripts were analyzed using conventional content analysis.

RESULTS

We enrolled 14 NHs across the United States and interviewed 42 personnel. Six themes emerged: Benefits of NHSN, External Support and Motivation, Need for a Champion, Barriers, Risk Adjustment, and Data Integrity. We did not find substantive differences in perceptions of NHSN value related to participants' professional roles or enrollment category. Some participants from newly enrolled NHs felt well supported through the NHSN enrollment process, while participants from earlier enrolled NHs perceived the process to be burdensome. Among participants from non-enrolled NHs, as well as some from enrolled NHs, there was a lack of knowledge of NHSN.

CONCLUSIONS

This qualitative study helps fill a gap in our understanding of barriers and facilitators to NHSN enrollment and reporting in NHs. Improved understanding of factors influencing decision-making processes to enroll in and maintain reporting to NHSN is an important first step towards strengthening infection surveillance in NHs.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration case study: Bloodstream infection-patient injection into vascular access 2018

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection surveillance definitions. These cases reflect some of the complex patient scenarios infection preventionists have encountered in their daily surveillance of health care-associated infections using NHSN definitions and protocols. Teaching points for this case study are.

Nursing home adoption of the National Healthcare Safety Network Long-term Care Facility Component

BACKGROUND

Health care-associated infections pose a significant problem in nursing homes (NHs). The Long-term Care Facility Component of the National Healthcare Safety Network (NHSN) was launched in 2012, and since then, enrollment of NHs into NHSN has been deemed a national priority. Our goal was to understand the characteristics of NHs reporting to the NHSN compared to other NHs across the country.

METHODS

To meet this goal, we quantified the characteristics of NHs by NHSN enrollment status and reporting consistency using the Certification and Survey Provider Enhanced Reporting (CASPER) data linked to NHSN enrollment and reporting data.

RESULTS

Of the 16,081 NHs in our sample, 262 (or 1.6% of NHs) had enrolled in NHSN by the end of 2015; these early adopting facilities were more likely to be for-profit and had a higher percentage of Medicare residents. By the end of 2016, enrollment expanded by more than 5-fold to 1,956 facilities (or 12.2% of NHs). In our analysis, the characteristics of those later adopting NHs were more similar to NHs nationally than the early adopters. Specifically, bed size and hospital-based facilities were related to both early and late adoption of NHSN.

CONCLUSIONS

The types of NHs that have enrolled in NHSN have changed substantially since the program began. The increased enrollment was likely due to the Centers for Medicare & Medicaid (CMS)-funded "C. difficile Infection (CDI) Reporting and Reduction Project" that incentivized Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to support NH enrollment and participation in NHSN. Further understanding of a facility's ability to enroll in and maintain reporting to NHSN, and how this relates to infection prevention staffing and infrastructure in NHs and infection rates among NH residents, is needed.

Long-term care facility National Healthcare Safety Network enrollment challenges, 2016

The Centers for Medicare & Medicaid Services has a national goal to increase the number of long-term care facilities reporting Clostridium difficile infection data to the Centers for Disease Control and Prevention. A partnership between the Tennessee Department of Health and the quality improvement organization, Qsource, helped facilitate successful enrollment into the National Healthcare Safety Network for nursing homes in the state of Tennessee.

Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing

Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy. The AHRQ metric analyzes chart-audited data and reflects both catheter use and care. The Centers for Disease Control and Prevention metric analyzes self-reported data and primarily reflects catheter care. Because analysis of the AHRQ metric showed a progressive change in performance over time and the scientific literature supports the importance of catheter use in the prevention of CAUTI, it is suggested that risk-adjusted catheter-use data be incorporated into metrics that are used for determining facility performance and for value-based purchasing initiatives.

An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units

BACKGROUND

Traditional methods of surveillance of catheter-associated urinary tract infections (CAUTIs) are error-prone and resource-intensive. To resolve these issues, we developed a highly sensitive electronic surveillance tool.

OBJECTIVE

To develop an electronic surveillance tool for CAUTIs and assess its performance.

METHODS

The study was conducted at a 947-bed tertiary care center. Patients included adults aged ≥18 years admitted to an intensive care unit between January 10 and June 30, 2012, with an indwelling urinary catheter during their admission. We identified CAUTIs using 4 methods: traditional surveillance (TS) (ie, manual chart review by ICPs), an electronic surveillance (ES) tool, augmented electronic surveillance (AES) (ie, ES with chart review on a subset of cases), and reference standard (RS) (ie, a subset of CAUTIs originally ascertained by TS or ES, confirmed by review). We assessed performance characteristics to RS for reviewed cases.

RESULTS

We identified 417 candidate CAUTIs in 308 patients; 175 (42.0%) of these candidate CAUTIs were selected for review, yielding 32 confirmed CAUTIs in 22 patients (RS). Compared with RS, the sensitivities of TS, ES, and AES were 43.8% (95% confidence interval [CI], 26.4%-62.3%), 100.0% (95% CI, 89.1%-100.0%), and 100.0% (95% CI, 89.1%-100.0%). Specificities were 82.5% (95% CI, 75.3%-88.4%), 2.8% (95% CI, 0.8%-7.0%), and 100.0% (95% CI, 97.5%-100.0%).

CONCLUSIONS

Electronic CAUTI surveillance offers a streamlined approach to improve reliability and resource burden of surveillance.

Surveillance of dialysis events: 12-month experience at five outpatient adult hemodialysis centers in Kuwait

BACKGROUND

Embedding dialysis surveillance scheme is associated with reductions in blood stream infection and antimicrobial consumption .The aim of this study was to establish baseline dialysis events (DE) rates; hospitalization, intravenous (IV) antibiotics start or a positive blood culture stratified by vascular access category and comparisons to published National Healthcare Safety Network (NHSN) rates.

METHODS

A retrospective review of DE was done between January to December 2012, in five outpatient adult hemodialysis center.

RESULTS

The pooled mean rates of hospitalization among patients with fistulas, grafts, permanent and temporary catheters were 2.8, 5.7, 5.1, and 10.6 per 100 patient-months, respectively. For positive blood culture the pooled mean rates were 0.2, 1.0, 1.9 and 2.7 per 100 patient-months in these groups. The IV antibiotics starts event pooled mean rates were 5.9, 9.0, 11.8, and 11.2 per 100 patient-months. DE were significantly more common in patients with permanent and temporary catheters when compared with patients with fistulas and graft (p<0.001).

CONCLUSION

Surveillance of DE rates in Kuwait revealed significantly lower mean rate of hospitalization and positive blood culture while IV antimicrobial start shows significantly higher mean rate when compared to published NHSN data.

A pilot study of Biotene OralBalance® gel for oral care in mechanically ventilated preterm neonates

BACKGROUND

Neonatal ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality. In adults on mechanical ventilation, timed oral care decreases the frequency of VAP, but this approach has not been studied in neonates.

OBJECTIVES

To evaluate the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel and estimate the required sample size for such a trial.

METHODS

Infants were eligible for enrollment if they were born before 28 weeks of gestation, and were mechanically ventilated between 7 and 10 postnatal days. Infants were randomized to receive timed oral care with Biotene OralBalance® gel or sterile water. All subjects were treated with a standard bundle of procedures to reduce the risk of VAP.

RESULTS

We enrolled 41 of 46 eligible infants (89%). Compliance with timed oral care protocol was 97%. No local oral side effects of Biotene OralBalance® gel were observed. There were no significant group differences in mortality or short-term outcomes, except length of hospital stay which was significantly shorter in the Sterile water group (p = 0.02). A lower rate of VAP was found in the Biotene group, although the difference was not statistically significant (9/1000 ventilator-days versus 17/1000 ventilator-days in the Sterile water group, respectively; p = 0.16).

CONCLUSIONS

The results of this pilot study support the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel for prevention of VAP in mechanically ventilated neonates.