Implementing and validating a home-infusion central-line-associated bloodstream infection surveillance definition

Abstract

Objective: Central-line-associated bloodstream infection (CLABSI) surveillance in home infusion therapy is necessary to track efforts to reduce infections, but a standardized, validated, and feasible definition is lacking. We tested the validity of a home-infusion CLABSI surveillance definition and the feasibility and acceptability of its implementation.

Design: Mixed-methods study including validation of CLABSI cases and semistructured interviews with staff applying these approaches.

Setting: This study was conducted in 5 large home-infusion agencies in a CLABSI prevention collaborative across 14 states and the District of Columbia.

Participants: Staff performing home-infusion CLABSI surveillance.

Methods: From May 2021 to May 2022, agencies implemented a home-infusion CLABSI surveillance definition, using 3 approaches to secondary bloodstream infections (BSIs): National Healthcare Safety Program (NHSN) criteria, modified NHSN criteria (only applying the 4 most common NHSN-defined secondary BSIs), and all home-infusion-onset bacteremia (HiOB). Data on all positive blood cultures were sent to an infection preventionist for validation. Surveillance staff underwent semistructured interviews focused on their perceptions of the definition 1 and 3-4 months after implementation.

Results: Interrater reliability scores overall ranged from κ = 0.65 for the modified NHSN criteria to κ = 0.68 for the NHSN criteria to κ = 0.72 for the HiOB criteria. For the NHSN criteria, the agency-determined rate was 0.21 per 1,000 central-line (CL) days, and the validator-determined rate was 0.20 per 1,000 CL days. Overall, implementing a standardized definition was thought to be a positive change that would be generalizable and feasible though time-consuming and labor intensive.

Conclusions: The home-infusion CLABSI surveillance definition was valid and feasible to implement.

Fig. 1.

Central-line–associated bloodstream infections (CLABSI) rates per month per 1,000 central venous catheter days based on rates as determined by the single central-study team validator. Rates are reported across all agencies based on the full National Healthcare Safety Network (NHSN) criteria, modified NHSN criteria, and home infusion onset bacteremia (HiOB) criteria.