nhsn definition change and clabsi rates 879 The initial increase in ourCLABSI rates in 2015 wasmainly due
to gram-positive bacteria (+1.6%; P<.001) (Table 2).Despite the exclusion of Candida spp as pathogens from the 2015 CAUTI definition, our catheter-related candidemia rates remained relatively unchanged in 2015 (+0.1%; P=.30). In fact, our catheter-related candidemia rates decreased significantly by 1.9% in 2016 (P<.001) (Table 2, 42.2% relative reduction). Additionally,we also saw a significant decline in our CLABSI rates secondary to gram-positive and gram-negative bacteria in 2016 (−5.6% and −1.7% absolute reduction, 40% and 29.3% relative reduction, respectively).
discussion
The revised 2015 NHSN CAUTI definition resulted in a significant decline inCAUTI rates,with a paradoxical increase in CLABSI rates related to Candida spp in some health systems.7,8 However, we did not see the same increase in catheter-related candidemia or a sustained increase in the CLABSI rates. The opposite trend was observed as both CLABSI rates and catheter-related candidemia rates decreased significantly in 2016 when vascular access guidelines were updated.
table 1. Incidence Rate (IR) per 1,000 Catheter Days Using the Applicable National Health Safety Network Definition
Year 2013
2014 2015 2016
Hospital-wide CLABSI IR
1.54 1.34 2.1
1.31
Hospital-wide CAUTI IR
4.95 3.42 0.92 0.80
ICU
1.59 1.83 0.91
NOTE. CAUTI, catheter-associated urinary tract infections; CLABSI, central line-associated bloodstream infections; ICU, intensive care unit.
ICU
CLABSI IR CAUTI IR 2.02
3.75 2.54 0.78 1.06
CAUTI definition resulted in a >75% decline in reportable CAUTIs.6 There was an initial increase in our CLABSI IR in 2015, but it was not driven by yeast, which suggests that these changes were likely unrelated to changes in the CAUTI defi- nition. This increase was due to gram-positive organisms, most likely contaminants. In 2016, a concerted effort was made to decrease CLABSI rates, which resulted in a significant decline in our hospital-wide and ICU CLABSI rates. We attributed this decline to a developing a vascular access policy that restricted surveillance blood cultures in asympto- matic patients and restricted drawing blood cultures from central lines, similar to that reported by Boyce et al.9 Reducing the number of contaminated blood cultures may have con- tributed to a significant reduction in our reported CLABSIs similar to other studies.10 With the 2015 NHSN CAUTI definition change, other
At our institution, we found that the current 2015 NHSN
health systems noted a paradoxical increase in their CLABSI rates, specifically catheter-related candidemia and enter- ococcemia. Fakih et al8 reported a >40% decrease in ICU CAUTI rates with a corresponding 30% increase in ICU CLABSI rates in their healthcare system with this change in definition. Their catheter-related candidemia and enter- ococcemia rates increased by 100% in 2015 compared to 2014. These candidemia and enterococcemia cases accounted for 40% of CLABSI events in 2015 compared to 25% in 2014.8 The increase in their catheter-related candidemia was assumed to be due to exclusion of CAUTI as an attributable source. However, candiduria is rarely clinically significant. Drogari-Apiranthitou et al11 conducted a 5-year clinical and molecular analysis of cases with candidemia and candiduria and found that concomitant candiduria is rare in hospitalized patients with candidemia, confirming previous reports. Hence, the 2015 NHSN
table 2. Organisms Causing CAUTI and CLABSI Events From 2014 to 2016 2014
2015
Observed Events
CLABSI Organisms Gram-positive bacteria
Gram-negative bacteria
Fungi
CAUTI Organisms Gram-positive bacteria
Gram-negative bacteria
Fungi
Device Days Ratea
Observed Events
Device Days Ratea
89 72,548 1.23 117 83,841 1.39 45 72,548 0.55 32 72,548 0.44 31 57,679 0.53 96 57,679 1.66 96 57,679 1.66
2014 vs 2015
Absolute Change, %
P Value
Observed Events
2016
Device Days Ratea
49 83,841 0.58 38 83,841 0.45 12 65,519 0.18 58 65,519 0.88 0 65,519 NA
+1.6 <.001 70 83,785 0.83 +0.3 +0.1
.01 .30
2015 vs 2016
Absolute Change, %
34 83,785 0.41 22 83,785 0.26
−3.5 <.001 13 62,843 0.21 −7.8 <.001 44 62,843 0.70
−5.6 −1.7 −1.9 +0.3 −1.8
NOTE. CLABSI, central line-associated bloodstream infections; CAUTI, catheter-associated urinary tract infections; NA, not available. aRate is reported per 1,000 catheter days.
P Value
<.001 <.001 <.001 <.001 <.001
−100 NA 0 62,843 NA NA NA
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