title: Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition.
abstract: OBJECTIVE
  To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).
  
  
  METHODS
  Multicenter field test.
  
  
  METHODS
  Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance.
  
  
  METHODS
  Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported.
  
  
  RESULTS
  Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; κ = 0.82). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing.
  
  
  CONCLUSIONS
  Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. isee@cdc.gov
authors.forename: Isaac
authors.initials: I
authors.lastname: See
authors.forename: Martha
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Kathy
authors.initials: K
authors.lastname: Allen-Bridson
authors.forename: Teresa
authors.initials: T
authors.lastname: Horan
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Magill
authors.forename: Nicola D
authors.initials: ND
authors.lastname: Thompson
mesh_terms: D016470:Bacteremia / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology; D055499:Catheter-Related Infections / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects; D003422:Critical Care; D003428:Cross Infection / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology; D016469:Fungemia / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006761:Hospitals; D006801:Humans; D007958:Leukocyte Count; D009092:Mucous Membrane / Q000293:injuries*; D009503:Neutropenia / Q000453:epidemiology; D009504:Neutrophils; D011159:Population Surveillance; D009626:Terminology as Topic; D014184:Transplantation, Homologous