changes in cdc clabsi definition - ko...
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Changes in CDC CLABSI DefinitionJanuary 2013 Version
Chris MansellClinical Microbiologist, Waikato Hospital
NZ CLAB Collaborative
Insertion Bundle Maintenance Bundle Surveillance
CDC definitions
CDC CLABSI Event definitions 4pschttp://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
Problems with CLAB Surveillance Definitions
Types of diagnosis– Biological aetiology– Clinical working diagnosis
– Surveillance• Quality improvement• Audit• Political
Value of Surveillance Definition
• Feedback metric for assessing effectiveness of changes in practice– An integral part of current quality
improvement methodology
• Incentive to implement good practice– Reinforces process changes as being
“patient and outcomes oriented” rather than “bureaucratic”.
Recognised factors devaluing the surveillance definition
• Sample collection and surveillance effort• Subjective interpretation
– Self reporting– Potential cases diverted to “Hospital Acquired
Infection at another site”• PNU1
• Capture of cases after patient discharge• Publication of “Time since last CLAB” and rates
– League tables– Celebrations– Unrealistic expectations
Refinement of Definitions for Central Venous Line Infection
Doubts ICHE 2010 31 1286
2008 VICNISS
CDC HAI 2008AJIC 2008 36 309
Meta analysis of definitionsCID 2011 53 697Connecticut audit
AJIC 2010 38 832
Victorian AuditICHE 2009 30 1045
NHSN review CID 2012 55 364
CDC CLABSI HAI and org list Jan 2013
CDC CLABSI June 2011VICNISS
Org list
June 2011
Jan 2013 CDC CLABSI • 17 pages - No Table of Contents
• Sections– Introduction– Settings– Requirements– Definitions– Tables
• 1. Lab Confirmed BSI Criteria• 2. Examples of how to report organisms• 3. Mucosal Barrier Injury LCBI Enterobacteriaceae• 4. Examples for MCI-LCBI
– Numerator data– Data analyses– Appendix 1. Secondary BSI guide
• 4 scenarios• Definition of matching organism• Notes• Reporting instructions
HAI
Primary BSI
Date of event
Central line
Infusion
Umbilical catheter
Temporary central line
Permanent central line
CLABSI
Location of attribution
Transfer rule
Jan 2013 CDC CLABSI • 17 pages - No Table of Contents
• Sections– Introduction– Settings– Requirements– Definitions– Tables
• 1. Lab Confirmed BSI Criteria• 2. Examples of how to report organisms• 3. Mucosal Barrier Injury LCBI Enterobacteriaceae• 4. Examples for MBI-LCBI
– Numerator data– Data analyses– Appendix 1. Secondary BSI guide
• 4 scenarios• Definition of matching organism• Notes• Reporting Instructions
HAI
Primary BSI
Date of event
Central line
Infusion
Umbilical catheter
Temporary central line
Permanent central line
CLABSI
Location of attribution
Transfer rule
CLABSI definition
LCBI CL or UC > 2 cal days
CLABSI
Secondary BSI
• Do these over ride CLABSI ?• What is primary vs secondary BSI ?
Primary LCBI CL or UC > 2 cal days
CLABSI
Secondary LCBI
Meets criteria for a site specific HAI
Not a CLAB
CDC HAI definitions 17pschttp://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf
Jan 2013 CDC CLABSI • 17 pages - No Table of Contents
• Sections– Introduction– Settings– Requirements– Definitions– Tables
• 1. Lab Confirmed BSI Criteria• 2. Examples of how to report organisms• 3. Mucosal Barrier Injury LCBI Enterobacteriaceae• 4. Examples for MBI-LCBI
– Numerator data– Data analyses– Appendix 1. Secondary BSI guide
• 4 scenarios• Definition of matching organism• Notes• Reporting Instructions
HAI
Primary BSI
Date of event
Central line
Infusion
Umbilical catheter
Temporary central line
Permanent central line
CLABSI
Location of attribution
Transfer rule
See next slide for details
Table 1. Laboratory Confirmed Bloodstream Infection Criteria
LCBI Criterion
LCBI 1
LCBI 2
timeframe measured in calendar days
List of 431 common commensals and 2000 total organisms
LCBI 3
MBI-LCBI criterion
MBI-LCBI 1 “intestinal organisms”
MCI-LCBI 2 “viridans group streptococci”
MCI-LCBI 3 “viridans group streptococci”
Comments
Clarifications• Location of attribution
– Date when last element occurred– Contractors– Wards which don’t have overnight patients
• Separate occasions for blood cultures• “No other organism isolated”• Graft vs Host Disease• Catheter tip cultures are not used• Unspeciated organisms
– More examples provided• “Special Care Areas/Oncology”• Standardised Infection Ratio
– New references included• Appendix 1 Secondary BSI guide
– More, expanded, slightly changed example cases– Blood and site specific cultures don’t have to be collected on the same day
• Reporting instructions– Don’t report secondary BSI for
• VASC• PNU1• VAC• IVAC
Jan 2013 CDC CLABSI • 17 pages - No Table of Contents
• Sections– Introduction– Settings– Requirements– Definitions– Tables
• 1. Lab Confirmed BSI Criteria• 2. Examples of how to report organisms• 3. Mucosal Barrier Injury LCBI Enterobacteriaceae• 4. Examples for MBI-LCBI
– Numerator data– Data analyses– Appendix 1. Secondary BSI guide
• 4 scenarios• Definition of matching organism• Notes• Reporting Instructions
HAI
Primary BSI
Date of event
Central line
Infusion
Umbilical catheter
Temporary central line
Permanent central line
CLABSI
Location of attribution
Transfer rule
Secondary BSI Guide
VASC
No culture required
PNU1No culture required
VAC & IVAC
Nested Criteria
• VAC = deterioration
• IVAC = Temp/WBC and Antibiotic treatment
No culture required