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220 Defining Preventable Catheter Associated Bloodstream Infections in Hematology Oncology Patients: Use of a Modified Definition and Its Impact on Rates and Pathogens

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Megan DiGiorgio, MSN, RN, CIC , Cleveland Clinic, Cleveland, OH
Cynthia Fatica, BSN, RN, CIC , Cleveland Clinic, Cleveland, OH
Mary A. Oden, BSN, MHS, CIC , Cleveland Clinic Health System, Cleveland, OH
Patti Akins, BSN, RN , Cleveland Clinic, Cleveland, OH
Mary Serafin, BSN, RN, MBA , Cleveland Clinic, Cleveland, OH
Julie Curtis, BSN, RN , Cleveland Clinic, Cleveland, OH
Brian Bolwell, MD , Cleveland Clinic, Cleveland, OH
Brad Pohlman, MD , Cleveland Clinic, Cleveland, OH
Matt Kalaycio, MD , Cleveland Clinic, Cleveland, OH
Mikkael A. Sekeres, MD, MS , Cleveland Clinic, Cleveland, OH
Steven M. Gordon, MD , Cleveland Clinic, Cleveland, OH
Thomas G. Fraser, MD , Cleveland Clinic, Cleveland, OH

 

Background:

Bone marrow transplant (BMT) and leukemia patients have inherent risks for hospital-acquired bloodstream infection (HABSI) due to their disease and treatment.  There is additional risk for HABSI due to the need for a central venous catheter (CVC).  Currently prescribed National Health Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) definitions are not specific for this patient population and may not adequately approximate events at bedside.

Objective:

To create a definition that better reflects the true burden of CLABSI in hematology oncology to support continuous quality improvement, and to compare rates and pathogens using both definitions.

Methods:

Infection Prevention (IP) surveillance at Cleveland Clinic includes total BSI, a determination of primary (to include CLABSI) and secondary.  Following NHSN methodology, central line days are counted daily on the 22 bed BMT unit, but are not available for the 22 bed leukemia unit.  Patient days are generated from an administrative database.  A multidisciplinary taskforce was formed to focus on decreasing HABSI.  Analysis of the NHSN definition included consultation with CDC, other cancer centers and experts in Infectious Disease.  A modified definition (MD) was developed.  CLABSI was defined using NHSN criteria; however, the following clinical scenarios were no longer considered CLABSIs or primary HABSIs:  (1) HABSI due to Viridans streptococcus in a patient with mucositis, (2) BMT recipients with GVHD of the GI tract with a HABSI due to Enterococcus species, Enterobacteriaceae, or Candida species, (3) patients neutropenic after chemotherapy with a HABSI due to Enterococcus species, Enterobacteriaceae, or Candida species.  Total HABSI surveillance was continued and results were maintained in an IP database.  Pathogens and rates were compared using AICE version 5.0.0 (BD Diagnostics) for the time period 1/1/10 through 9/30/10.

 

Results:

During the observation period there were 744 admissions comprising 9989 patient days.  The rate of HABSI was 9.9 per 1,000 patient days.  Primary rate was ­8.6 per 1000 patient days by NHSN and 2.7 by MD (p < 0.001).  Secondary rate was 1.2 per 1000 patient days by NHSN and 7.1 by MD (p < 0.001).  BMT CLABSI rate by NHSN was 7.0 per 1000 CVC days and by MD was 2.4 (p = 0.002) (Figure 1).  Top 3 CLABSI pathogens by NHSN were Enterococcus species, Enterobacteriaceae species and viridans group streptococci.  Top 3 CLABSI pathogens by MD were coagulase-negative staphylococci (CNS), S. aureus and Pseudomonas aeruginosa. CNS became a significant CLABSI pathogen using the MD vs. NHSN (p = 0.01).

Conclusions:

A MD of CLABSI for hematology oncology to support ongoing quality improvement efforts was associated with a decrease in CLABSI rate and an alignment of pathogens more associated with line-related disease.