Table 2.
Home Health Care Agency Central Line–Associated Bloodstream Infection (CLABSI) Definitions and Selected Qualitative Responses*
| Question | N= 50 (%)† | Selected Qualitative Responses |
|---|---|---|
| What definition does your agency use to define a CLABSI? | ||
| ■ CDC National Healthcare Safety Network‡ | 21 (42) | “We don’t have an official definition.” |
| ■ Association for Professionals in Infection Control and Epidemiology definition for home health care§ |
4 (8) | “Anyone with a cellulitis.” |
| ■ Another organization’s definition | 4 (8) | |
| ■ Unknown | 19 (38) | |
| ■ Agency-specific definition | 2 (4) | |
| How do you define the numerator (event) for your agency’s CLABSI? For example: | ||
| ■ A positive blood culture without another source of infection | 8 (16) | “Physician documented suspected infection” |
| ■ Any positive blood culture | 23 (46) | “Positive symptoms of infection 48 hours after discharge” |
| ■ A positive blood culture > 48 hours after discharge | 9 (18) | “Admission to the hospital” |
| ■ Other | 8 (16) | “Whenever the hospital tells us a line was removed |
| ■ Unknown | 2 (4) | for a CLABSI” |
| How do you define the denominator for your agency’s CLABSIs? For example: | ||
| ■ Each day a patient has a central line in our care | 27 (54) | “No definition yet.” |
| ■ Each patient with a central line | 19 (38) | |
| ■ Unknown | 4 (8) | |
| How long does a patient need to be discharged from the hospital in order for you to count his or her CLABSI? | ||
| ■ Less than 2 days | 10 (20) | “30 days” |
| ■ 2 days | 22 (44) | “21 days” |
| ■ 3–4 days | 6 (12) | “0 hours” |
| ■ 7 or more days | 7 (14) | |
| ■ Unknown | 5 (10) | |
| When do you stop counting patients in your denominator? | ||
| ■ 2 days after discharge from home health care | 1 (2) | |
| ■ When discharged from home health care or central line removed | 45 (90) | |
| ■ Unknown | 4 (8) | |
| Who makes the final determination of a CLABSI? (job title) | ||
| ■ Infection preventionist | 7 (14) | “No specific person” |
| ■ Quality assurance person | 6 (12) | “Doctor at the hospital” |
| ■ Other║ | 31 (62) | “Owner” |
| ■ Unknown | 6 (12) | “Pharmacist” |
| How does your agency evaluate the effectiveness of its CLABSI prevention efforts? | ||
| See Table 3, Question A4 | “We do not evaluate, we think what we’re doing is working well.” |
|
| “We’ve only had one CLABSI so it’s not an issue.” | ||
| “We don’t have a good tool because we have really low rates and don’t need one.” [This agency reported not knowing its CLABSI rate.] |
||
| “We don’t because we’ve never had any infections.” | ||
| During which events is removal of catheter considered/discussed with the medical team? (can report more than one)# | ||
| ■ At every visit | 2 (4) | “Fever over 100.5°F” |
| ■ At conclusion of therapy | 27 (47) | “According to doctor’s orders” |
| ■ Infection/clot/dislodged/other adverse event | 43 (75) | |
| ■ Not considered/discussed | 7 (12) | |
CDC, Centers for Disease Control and Prevention.
The seven agencies that did not track CLABSI rates or did not know if they did so were not included in this table.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–332.
Association for Professionals in Infection Control and Epidemiology. APIC - HICPAC Surveillance Definitions for Home Health Care and Home Hospice Infections. Feb 2008. Accessed Jun 17, 2013. http://www.apic.org/resource_/tinymcefilemanager/practice_guidance/hh-surv-def.pdf.
Many “other” responses included positions such as Director of Nursing, Pharmacist, and Ordering Physician. It is unclear if these people or people listed as “Quality Assurance” had Infection Preventionist training.
N = 57 for this question. Percentages do not equal 100% because respondents could report more than one option.