title: Evaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units.
abstract: OBJECTIVE
  To evaluate the application of the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce CLABSIs; to identify sources of variability in the application of the definition.
  
  
  METHODS
  Online survey using 18 standardized case scenarios. Each described a positive blood culture in a patient and required a yes- or-no answer to the question "Is this a CLABSI?" NHSN staff responses were the reference standard.
  
  
  METHODS
  Sixty-five US PICUs and PHOUs.
  
  
  METHODS
  Staff who routinely adjudicate CLABSIs using NHSN definitions.
  
  
  RESULTS
  Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios evaluating application of 1 of the 3 criteria ("known pathogen," 78% [1.7%]; "skin contaminant, >1 year of age," 76% [SE, 2.5%]; "skin contaminant, ≤1 year of age," 81% [3.8%]; [Formula: see text]). The mean percentage of concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was present or incubating on admission (64% [4.6%]; [Formula: see text]) or to distinguish between primary and secondary bacteremia (65% [2.5%]; [Formula: see text]).
  
  
  CONCLUSIONS
  The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary from secondary bloodstream infection are needed.
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. aditya.gaur@stjude.org
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
authors.forename: Cuilan
authors.initials: C
authors.lastname: Gao
authors.forename: Carol
authors.initials: C
authors.lastname: Rosenberg
authors.forename: Gloria C
authors.initials: GC
authors.lastname: Morrell
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.forename: W Charles
authors.initials: WC
authors.lastname: Huskins
mesh_terms: D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D006405:Hematology / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic / Q000592:standards; D014481:United States / Q000453:epidemiology