More than 80% of centers reported having a formal, written policy about obtaining blood cultures, but less than 80% of these address obtaining samples from patients with central venous lines, and any such policies are reportedly followed less than half of the time.
All of the surveyed infection control practitioners in the study said they used the Centers for Disease Control and Prevention's definition for CA-BSI, but none actually did, says Niedner. This has significant implications in the era of mandatory public reporting, pay-for-performance and Medicare's 'never events.'" The Centers for Medicare & Medicaid Services lists CA-BSI as a never event, and no longer reimburses for such hospital-acquired infections.
The study also showed that more aggressive surveillance efforts correlate with higher catheter-associated bloodstream infections rates. This suggests "that the harder one looks for CA-BSIs, the more likely they are to find them," Niedner says.
"From an internal perspective, you want an aggressive surveillance system that is inclusive of all possible cases, but from a public reporting or pay-for-performance standpoint, you'd like to exclude as many cases as you can," Niedner says. "There are no definitive national standards as to how to go about doing CA-BSI surveillance at the clinical practice level. It leaves wiggle room that pits hospital economics and reputation against quality improvement teams."
"If you are interested in improving quality of care, you look hard, if you're interested in reputation and reimbursement, maybe you don't look so hard," Niedner adds.
The study's findings offer a compelling opportunity for hospitals to improve their CA-BSI surveillance as a means to promote valid comparison among institutions, Niedner says. Current publicly reported data show that some hospitals report a four-fold differen
|Contact: Margarita B. Wagerson|
University of Michigan Health System