2179. Variability in the Application of Surveillance Definitions for Central Line-Associated Bloodstream Infection Across U.S. Hospitals

BACKGROUND: In 2015, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS) reminded hospitals of the importance of using standardized surveillance definitions to report healthcare-associated infections (HAIs). Concerns remain, however, about how hospitals apply these definitions. METHODS: We performed a survey via the Society for Healthcare Epidemiology of America’s Research Network exploring reporting differences for central line-associated bloodstream infection (CLABSI) in U.S. hospitals. Three patient scenarios were presented, and respondents were asked to determine whether the infection was a CLABSI reportable to the CDC’s National Healthcare Safety Network (NHSN), a secondary bloodstream infection, or an infection present on admission. Hospitals were also asked how they adjudicate cases when having a difficult time determining the type of infection, including whether hospitals contact NHSN, ask for physician or committee guidance on HAI determination, or rely solely upon NHSN definitions. RESULTS: We sent the survey to 88 U.S. hospitals and received a response from 42 (48%). The respondents included 32 infection preventionists (IPs) and 10 non-IPs involved in infection prevention. Respondents correctly classified the case 79.4% of the time (100 out of 126 reviewed scenarios, 3 per respondent), assigned an attribution that would have led to under-reporting 14.3% of the time (18/126), and assigned an attribution that would have led to over-reporting 6.3% of the time (8/126). Respondents from academic medical centers (AMCs) were more likely to accurately report infections with no under reporting (P-value 0.03) than respondents from other types of hospitals. When adjudicating difficult cases, 38/42 (90%) stated that they use the NHSN manual and/or write to NHSN, but physician input (18/42, 43%) or committee input (10/42, 24%) were also common. Of note, 4/42 hospitals (10%) stated that they rely only on physician/committee input. CONCLUSION: Our findings suggest variability in the application of NHSN surveillance criteria for CLABSI, with a high reliance on physician or committee review. This appears to result in higher under-reporting by non-AMCs. DISCLOSURES: All authors: No reported disclosures.