title: Statewide validation of hospital-reported central line-associated bloodstream infections: Oregon, 2009.
abstract: BACKGROUND
  Mandatory reporting of healthcare-associated infections is common, but underreporting by hospitals limits meaningful interpretation.
  
  
  OBJECTIVE
  To validate mandatory intensive care unit (ICU) central line-associated bloodstream infection (CLABSI) reporting by Oregon hospitals.
  
  
  METHODS
  Blinded comparison of ICU CLABSI determination by hospitals and health department-based external reviewers with group adjudication.
  
  
  METHODS
  Forty-four Oregon hospitals required by state law to report ICU CLABSIs.
  
  
  METHODS
  Seventy-six patients with ICU CLABSIs and a systematic sample of 741 other patients with ICU-related bacteremia episodes.
  
  
  METHODS
  External reviewers examined medical records and determined CLABSI status. All cases with CLABSI determinations discordant from hospital reporting were adjudicated through formal discussion with hospital staff, a process novel to validation of CLABSI reporting.
  
  
  RESULTS
  Hospital representatives and external reviewers agreed on CLABSI status in 782 (96%) of 817 bacteremia episodes (k = 0.77 [95% confidence interval (CI), 0.70-0.84]). Among the 27 episodes identified as CLABSIs by external reviewers but not reported by hospitals, the final status was CLABSI in 16 (59%). The measured sensitivities of hospital ICU CLABSI reporting were 72% (95% CI, 62%-81%) with adjudicated CLABSI determination as the reference standard and 60% (95% CI, 51%-69%) with external review alone as the reference standard (P = .07). Validation increased the statewide ICU CLABSI rate from 1.21 (95% CI, 0.95-1.51) to 1.54 (95% CI, 1.25-1.88) CLABSIs/1,000 central line-days; ICU CLABSI rates increased by more than 1.00 CLABSI/1,000 central line-days in 6 (14%) hospitals.
  
  
  CONCLUSIONS
  Validating hospital CLABSI reporting improves accuracy of hospital-based CLABSI surveillance. Discussing discordant findings improves the quality of validation.
authors.affiliation: Public Health Division, Oregon Health Authority, Portland, Oregon, USA.
authors.forename: John Y
authors.initials: JY
authors.lastname: Oh
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Cunningham
authors.forename: Zintars G
authors.initials: ZG
authors.lastname: Beldavs
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tujo
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Moore
authors.forename: Ann R
authors.initials: AR
authors.lastname: Thomas
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cieslak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D011159:Population Surveillance; D055815:Young Adult