CLABSI rates in immunocompromised patients: a valuable patient centered outcome?

The accepted approach to surveillance for hospital-acquired bloodstream infection (HABSI) due to central venous catheters requires use of the National Health and Safety Network (NHSN) definition for catheter-associated bloodstream infection (CLABSI). In this commentary, we discuss our experience with the application of current NHSN surveillance definitions for CLABSI and the impact that public reporting of CLABSI rates in settings with a high prevalence of special populations has on infection prevention (IP) programs. For IP programs to serve the continuous improvement needs of their organizations, surveillance methodologies need to accurately capture the burden of preventable HABSI among immunocompromised individuals with inherent risk for infection. Current NHSN CLABSI definitions lack specificity for complex and heterogeneous patient populations and require modification. Beyond definitions, IP programs must critically assess the value of their current approach to surveillance to assure that patient-centered outcomes are the focus of prevention efforts.