660 Application of the National Healthcare Safety Network (NHSN ) Central Line Associated Bloodstream Infection (CLA-BSI) Definition to Oncology Patients: Impact in the Trenches

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Miriana Pehar, RN , The Johns Hopkins Hospital, Baltimore, MD
Polly Ristaino, MS, CIC , The Johns Hopkins Hospital, Baltimore, MD
Alicia P. Budd, MPH , The Johns Hopkins Hospital, Baltimore, MD
Donna Fellerman, RN, BA, CIC , The Johns Hopkins Hospital, Baltimore, MD
Lisa L. Maragakis, MD , The Johns Hopkins Hospital, Baltimore, MD
Sara E. Cosgrove, MD, MS , The Johns Hopkins Hospital, Baltimore, MD
Trish Perl, MD, MSc , The Johns Hopkins Hospital, Baltimore, MD
Background: Central line associated bloodstream infections (CLA-BSI) require additional treatment and are associated with prolonged hospitalization and an increased risk of mortality.  The Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), provides a standardized definition and methods for facilities to monitor infectious complications, specifically, surveillance of CLA-BSI so that rates between hospitals with similar patient populations can be compared.  However, because of the impact of treatment and host issues, the validity of the CLA-BSI definition among oncology patients has been questioned.

Objective: Evaluate the use and interpretation of the CDC CLA-BSI definition in the oncology population among different hospitals.

Methods: Teaching hospitals that provide oncology services, including but not limited to hematologic malignancy, were asked to respond to a survey with standardized questions.  The questions in the survey addressed how the NHSN CLA-BSI definition was applied when determining the presence of a primary CLA-BSI, and whether or not mucositis and/or graft vs host disease (GVHD) was considered in determining whether a CLA-BSI was primary or secondary.

Results: A total of 22 hospitals across the country were surveyed and 11 responses were received (50%). All hospitals treat patients with various malignancies including but not limited to hematologic malignancies and bone marrow transplant (BMT).  The average number of beds was 814.   Nine of the 11 responses followed NHSN definitions (81%) and 10 out of the 11 responses (90%) did not consider or stratify by GVHD or mucositis when determining whether a CLA-BSI is primary or secondary.  Only 2 out of 11 (18%) surveyed felt that the NHSN definition, as it is currently written, appropriately captures CLA-BSIs in the oncology population.  However, 11 out of 11 (100%) of the responders agreed that more specific definitions need to be developed in order to assess CLA-BSI in the oncology population.

Conclusions: In this small survey of tertiary care medical centers, infection prevention and control groups reported varying interpretations of the NHSN definition to identify and classify CLA-BSIs in oncology patients.  There was unanimous consensus that more specific criteria need to be developed to address uniformity in identifying primary CLA-BSIs in the oncology population.  Academics, SHEA, and APIC need to work with the CDC to better adapt the CLA-BSI definition to this and other special patient populations.