Infection Control & Hospital Epidemiology (2018), 39, 1210–1215 doi:10.1017/ice.2018.187
Original Article
Surveillance for central-line–associated bloodstream infections: Accuracy of different sampling strategies
Elani Kourkouni MSc1, Georgia Kourlaba1, Evangelia Chorianopoulou1, Grammatiki-Christina Tsopela1, Ioannis Kopsidas1, Irene Spyridaki1, Sotirios Tsiodras2, Emmanuel Roilides3, Susan Coffin4 and
Theoklis E. Zaoutis1 for the PHIG investigators 1Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece, 24th Department of Medicine National and Kapodistrian University of Athens Medical School, Athens, Greece, 33rd Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece and 4Division of Infectious Diseases, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Abstract
Background: Active daily surveillance of central-line days (CLDs) in the assessment of rates of central-line–associated bloodstream infections (CLABSIs) is time-consuming and burdensome for healthcare workers. Sampling of denominator data is a method that could reduce the time necessary to conduct active surveillance. Objective: To evaluate the accuracy of various sampling strategies in the estimation of CLABSI rates in adult and pediatric units in Greece. Methods: Daily denominator data were collected across Greece for 6 consecutive months in 33 units: 11 adult units, 4 pediatric intensive care units (PICUs), 12 neonatal intensive care units (NICUs), and 6 pediatric oncology units. Overall, 32 samples were evaluated using the following strategies: (1) 1 fixed day per week, (2) 2 fixed days per week, and (3) 1 fixed week per month. The CLDs for each month were estimated as follows: (number of sample CLDs/number of sampled days) × 30. The estimated CLDs were used to calculate CLABSI rates. The accuracy of the estimated CLABSI rates was assessed by calculating the percentage error (PE): [(observed CLABSI rates − estimated CLABSI rates)/observed CLABSI rates]. Results: Compared to other strategies, sampling over 2 fixed days per week provided the most accurate estimates of CLABSI rates for all types of units. Percentage of estimated CLABSI rates with PE ≤±5% using the strategy of 2 fixed days per week ranged between 74.6% and 88.7% in NICUs. This range was 79.4%–94.1% in pediatric onology units, 62.5%–91.7% in PICUs, and 80.3%–92.4% in adult units. Further evaluation with intraclass correlation coefficients and Bland-Altman plots indicated that the estimated CLABSI rates were reliable. Conclusion: Sampling over 2 fixed days per week provides a valid alternative to daily collection of CLABSI denominator data. Adoption of such a monitoring method could be an important step toward better and less burdensome infection control and prevention.
(Received 8 May 2018; accepted 14 July 2018; electronically published August 29, 2018)
Healthcare–associated infections (HAIs) are by far the most common complications affecting hospitalized patients throughout the world today.1 The reduction of HAIs has become a major focus of attention in healthcare systems worldwide over the last decade, and monitoring rates of HAIs has become an important quality-improvement measure.2 In Greece in particular, HAIs have become a widespread and urgent problem. One of the most common HAIs, not only in Greece but worldwide, is central-line– associated bloodstream infection (CLABSI).3,4 CLABSIs are associated with considerable morbidity and mortality, as well as high expenditure for national healthcare systems.5,6 Surveillance is a necessary tool for monitoring CLABSI rates as well as for making progress toward preventing CLABSIs both within hos- pitals and at the national level.
Author for correspondence: Elani Kourkouni MSc, Center for Clinical Epidemiology
and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece. E-mail:
elenkourkouni@hotmail.com
Cite this article: Kourkouni E. et al. (2018). Surveillance for central-line–associated bloodstream infections: Accuracy of different sampling strategies. Infection Control & Hospital Epidemiology 2018, 39, 1210–1215. doi: 10.1017/ice.2018.187
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
The Centers for Disease Control and Prevention (CDC)
states that for the collection of CLABSI denominator data, a daily count of the number of patients and of the number of patients with 1 or more central lines in place (ie, central-line days, CLDs) in each unit under surveillance is required.7 Unfortunately, active daily surveillance of CLDs in the assess- ment of CLABSI rates is time-consuming and burdensome for healthcare workers,1 which can lead to gaps in the collection of data, especially in resource-limited healthcare systems (as in Greece). Sampling of denominator data is a method that could reduce the time necessary to conduct active surveillance. Furthermore, the introduction of such a technique could enhance the interest of unit personnel in monitoring CLABSI rates. Previous studies have assessed the use of sampling to collect CLDs and suggest that it is applicable mostly in adult intensive care units (ICUs).8–12
The primary objective of this study was to evaluate
the accuracy of various sampling strategies in the estimation of CLABSI rates compared to actual CLABSI rates, based on the daily collection of denominator data not only in adults
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